EP 



IBM 



A BRIEF TREATISE 



THERAPEUTICS 



J/MILNER FOTHERGILL, M.D., M.R.C.P. 



Edited for the U. S. Pharmacopeia 



WM. H. ROUSE, M. D., PH. C. 



With the addition of Chapters on 



DIET FOR THE SICK, 



By Mrs. Emma Draxt, Matron of the Michigan 
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Ai. '77^-Y 




SEP 



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The Illustrated Medical, Journal Co. 

Copyrighted 1884. 



?i 



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A BRIEF TREATISE 



THERAPEUTICS 



BY J. MILNEB, FOTHERGILL, M. D., M. R. C. P. 



INTRODUCTION. 

HOW TO CONSTRUCT A PRESCRIPTION. 

The student, when brought in contact with 
disease single-handed and alone, is often 
sorely puzzled to tell what to prescribe, and 
how to go about it. He may have heard lec- 
tures on the practice of physic, and been told 
that constipation may be treated by vegetable 
and mineral purgatives; but how to combine 
them, and in what doses to give them, he is 
unable to decide. Or he may have heard 
Materia Medica lectures, and been told that 
iron is indicated in anaemia; but he is far 
from seeing his way to prescribe it satisfac- 
torily. Suppose the case is that of a pallid 
man, with constipated bowels : the first thing 
to be done is to select a suitable laxative, say 
sulphate of magnesia. Now comes the dose. 
As it is to be taken several times a day, the 
dose must be much less than when given in 
one dose, as a purgative. For the latter, the 
average dose is %i; but as a laxative it will 
be found that £j. is usually quite sufficient 
three times a day. Then there is the anaemia 



INTRODUCTION. 



to be considered. For this the old tincture 
of the muriate of iron is well adapted, in a 
dose of ten drops at a time. We have now 
got the main elements of the prescription 
together, viz. : Magnesium Sulphate, gj., and 
Tine. Fer. Mur. tti,x. But in all probability 
this mixture will gripe the patient more or 
less unless it be given with some warm agent 
or carminative. Consequently, then, the 
vehicle in which the essential factors are to 
be taken is a not unimportant matter. If the 
appetite be good, then mint water may be 
selected. The complete prescription would 
then stand: 

Magnesium Sulphate, 3 j. 

Tincture of Iron, tijjx. 

Mint water, \ i. 
Three times a day. 

But if, as is very likely, the appetite is 
defective., it is well to select a vegetable bit- 
ter as the vehicle. As many of these vege- 
table bitters contain tannin, they do not go 
well with iron, giving an inky color to the mix- 
ture, and so rendering it repulsive to the eye. 
And medicine is not usually very attractive 
at the best; so it need not be made more ob- 
jectionable than is absolutely unavoidable. 
So the bitter selected may be infusion of 
quassia. But quassia is not carminative, so 
it is well to add either tincture of ginger or 
of capsicum. The prescription would then 

stand : 

Magnesium Sulphate, 3 j. 
Tincture of Iron, hex. 
Tincture of Ginger, 3 j. 
Or Tincture of Capsicum, njliv. 
Infusion of Quassia, $ i. 
Three times a day. 

Or the patient has a cold, with some bron- 
chial inflammation present. Then the line 



HOW TO CONSTRUCT A PRESCRIPTION. 5 

would go in this direction : First we require 
an agent which will make the action of 
coughing more efficient, while it also acts 
upon the bronchial lining membrane, making 
the secretion more free, and thus causing the 
phlegm to be more easily dislodged. Such 
an agent we find in ipecacuan. Say, then, 
ipecacuan wine fifteen minims. Then, in all 
febrile conditions, it is well to excite the 
action of the skin. For this end the acetate 
of ammonia is indicated. As I do not intend 
to confine myself to prescriptions in English, 
but shall use Latin ones at times, for the bet- 
ter education of the reader, so as to familiar- 
ize him with both, this will stand: 

Liq. A mm. Acetat., §i. 
Vini Ipecacuan, TTgxv. 
6ta quaque hora. 

Or the patient is recovering from some 
acute disease, as typhoid fever, or pneumo- 
nia, and the tongue is not quite clean, and 
the appetite not active. Here a mineral acid 
is indicated, as phosphoric, for instance; in a 
vegetable infusion which need not be free 
from tannin, as iron is not to be in this 
mixture. Consequently the prescription will 
stand thus : 

Dilute Phosphoric Acid, TTfixv. 

Infusion of Cinchona, $ i- 
Thrice daily. 
Under this combination probably the tongue 
will clean and the appetite improve. 

Then it is well for the student not to forget 
that acids and alkalies do not go together, but 
combine, a fact not always remembered by 
young practitioners. Thus, for instance, in 
dyspepsia with much acidity, it would not do 
to write the following prescription : 

Sodse Bicarb., 3ss. 
Liq. Strychnice, nuiv. 
Inf. Gentian, ?i. 



6 INTRODUCTION. 

The strychnine being dissolved in an acid 
medium, hydrochloric acid, would be thrown 
down in an alkaline mixture, with this result, 
the strychnine would be at the bottom of the 
mixture, and consequently the patient would 
get none of it ; till he came to the last dose, 
and then he might get more at once than was 
quite agreeable. In such cases the Galenical 
preparation must be chosen, the Tincture of 
Nux Vomica, The prescription then ought to 

stand : 

Sodae Bicarb., 3ss. 
Tinct. Nucis Vom., npx. 
Inf. Gentian, |i. 
Ter in die. 

To give iron with a vegetable bitter con- 
taining tannin is a very common error, pro- 
ducing a repulsive looking fluid. But this 
avoidance of incompatibles went to an unde- 
sirable length, when it decided that digitalis 
could not be combined with tincture of iron. 
In cases of heart weakness the following is 
an excellent combination : 

Tinct. Digitalis, llflx. 
Tinct. Ferri. Mur., njjx. 
Sp. Chloroform, nf>xx. 
Inf. Quassiae, f i. 
Ter in die. 

Spirit of Chloroform is pleasant to the taste, 
and can often be added to mixtures with ad- 
vantage ; it is also a stimulant. 

Or a patient may have constipation, with a 
foul tongue and a bad taste in the mouth. 
Here the fur, which consists of dead epithe- 
lium cells which are not properly shed, is 
usually stained by the bitter bile acids or 
their salts, so it is well to give a laxative 
which will also contain an ingredient which 
will act upon the liver, as mercury, for in- 
stance. The combination would then stand 
thus: 



INDICATIONS FOR TREATMENT. 



Pil. Hydrarg., gr. i. 

Pil. Col. Co., gr. iii. 

To be taken at bed-time. 

If the bowels are not freely opened, then a 
seidlitz powder, or an ounce of "black 
draught " in some warm water next morning. 
Morning laxatives should always be taken 
warm By so doing their action is more 
rapid, and the bowels are less apt to tease the 
patient during the course of the day, which 
is often very inconvenient. These minor 
matters are usually worth attention. 

INDICATIONS FOR TREATMENT. 

After making a diagnosis as to what is 
the matter with a patient, the next thing to 
be done is, to determine what is the lead- 
ing indication for treatment. The patient 
may be suffering acute pain, as in colic. 
Here the pain is at times excruciating and 
must be relieved. For this end opium 
stands facile princeps. "Mash Allah" (the 
Gift of God) is stamped on the cakes of 
opium by the Orientals. Then, as the colic 
is due to violent spasm of the muscular 
fibre of the intestine, it is well to give the 
opium with a carminative, as mint water, 
for instance, which will make a convenient 
vehicle. Then the pain is very depressing, 
as all pain is in which the abdominal portion 
of the sympathetic nerve is involved, and 
therefore a diffusible stimulant, acting rap- 
idly, is desirable. Such an agent we possess 
in carbonate of ammonia, of which sal vola- 
tile is a preparation. It would be well, then, 
to let the prescription stand: 

Tinct. Opii, 3 ss. 
Sal Volatile, 3 i. 
Aq. Menth. Pip., |i. 
Statim. 



INTRODUCTION. 



In these cases of severe depressing pain, a 
full dose of opium at once is in every way 
better than repeated small doses. (A word 
of caution as to dose. Children are very sus- 
ceptible to opium, and small doses often act 
very potently upon them. All agents which 
"depress " nerve action as part of their effect, 
are to be given with caution to children.) In 
many cases of colic the only thing at hand 
may be some laudanum and some spirits. It 
would then be well to give the laudanum, 
with two ounces of any spirit. In any case 
of colic, it is well to put cloths wrung out of 
hot water, and freely sprinkled with turpen- 
tine, upon the abdomen until relief is attained. 

Or the patient may be in a fit. Here really 
little can be done except to see that the patient 
does not do himself or herself any injury, if 
convulsed. In epilepsy, to loosen the collar 
and free the neck is indicated; and if the 
tongue is being bitten, put a piece of soft 
wood or a cork, betwixt the teeth to prevent 
the tongue being nipped. If a young woman, 
and especially screaming, it is probably 
hysteria, and then a jugful of cold water 
dashed over the head and face is effective, or 
a hand may be placed over the nose and 
mouth till the performance is arrested, and 
converted into a struggle to breathe. If it is 
pure syncope, it is well to allow the patient 
to remain in the recumbent posture until 
spontaneous efforts are made by the patient. 
In syncope there is temporary failure of the 
heart's action, and it is not desirable to re- 
move the patient from the horizontal posture, 
until there is evidence of the circulation 
being restored. If the patient be not in the 
horizontal posture when the faint comes on, 
she should at once be laid flat. 



INDICATIONS FOR TREATMENT. 



Or the patient may be bleeding profusely. 
Here it is desirable to put pressure on the 
vessels from which the blood flows. If 
from an artery, the pressure must be be- 
tween the heart and the bleeding orifice; if 
a vein, at the distal end of the limb ; if hae- 
moptysis, or haematemesis, keep the patient 
absolutely still under all circumstances. 

And now let me tell the youthful reader 
what he must not do. He must not give a 
stimulant if the patient faint. Here syncope 
is nature's mode of arresting the haemorr- 
hage; and though it may appear to indicate 
a supine and indifferent attitude, it is not 
wise to interfere with the syncope. To give 
a stimulant is to excite the heart's action, 
rouse the circulation, and restore the haemorr- 
hage. But so carry yourself that the alarmed 
bystanders shall recognize the fact that your 
inactivity is not the consequence of ignorance 
and indifference, but of greater knowledge 
than they possess. In their good intentions, 
persons guided by impulse, combined with 
ignorance, may become murderers. 

Or a patient may be suffering from great 
excitement, from brain disturbance, or from 
being mentally upset. Here a calm, self- 
possessed manner and bearing are of the 
greatest service, but medicine may be useful. 
Here a sedative is indicated, as chloral hy- 
drate, or bromide of potassium — alone or 
combined, and they may be given in what is 
termed a calmative, as camphor mixture, for 
instance. The prescription would stand : 

Chloral Hydrate, 3 ss. 
Potass. Bromid., 3 ss. 
Mist. Camphorse, I i. 



If required, this must be repeated in three or 
four hours. All depressant drugs are to be 



10 INTRODUCTION. 



given with care and prudence, and the action 
of opium, chloral, and bromide of potassium 
will be contrasted in a subsequent chapter. 

Or the patient may be suffering from dysp- 
noea — the respiratory efforts being very 
laborious. Here it is well to give rapidly 
diffusible stimulants, which act promptly on 
the centres of the circulation and the respira- 
tion. Such agents we possess in ammonia, 
belladonna, and strychnia, while digitalis 
acts powerfully upon the heart. It will be 
well to prescribe in severe dj^spncea either : 

Amm. Carb., gr. v. 
Sp. Chloroform, Tlpxx. 
Liq. Atropise Sulph., Tip. 
Aq., Ji 

to be repeated in two or three hours; or if 
the right ventricle be failing, the prescription 
would be : 

Am. Carb., gr. v. 

Tinct. Nuc. Vom., ltpx. 

Tinct. Digitalis, ttex. 

Aq. Menth. Pip., § j. 

also to be repeated if necessary. Or if the 
reader be very inexperienced, and not famil- 
iar with modern therapeutical research, he 
might take a lower but safer (i. e. as regards 
public opinion, but not as regards the pa- 
tient's life) standing ground, and prescribe: 

Sal Volatile, 3 i. 
Sp. Chloroform, 3 ss. 
Aq., Si 
4ta quaque hora. 

Where there is acute indigestion, it is well to 
empty the stomach by administering an 
emetic, as sulphate of zinc (jss), or ipecacuan 
wine (an ounce); or if these be not at hand, 
some mustard and hot water, or tickle the 
fauces with a finger until vomiting is induced. 
The same holds good of acute alcoholism. 
In all emergencies keep as cool as possible, 
and do not act hurriedly or excitedly, or you 







may do the wrong thing and defeat your 
aim. 

Then there is the question of the local 
measures to be employed. Heat is almost 
always soothing, except in headache, where 
cold applications give more relief. Cold 
water and vinegar, and eau de cologne, where 
practicable, are good measures for headaches. 
In dyspnoea, where the. right side of the heart 
is embarrassed, it is well to put hot poul- 
tices to the front of the chest; the heat stim- 
ulates the heart. In local abscesses a hot 
poultice is soothing. The case may be one 
of a broken rib, where a jagged end is rub- 
bing the lung-pleura at every respiratory act; 
here the most efficient local measure is to put 
the parts at rest, or as near as is attainable, 
by strapping or banding. In that form of 
pleurisy where a small nodule of tubercle, 
protruding from the lung, rubs on the costal 
pleura, and excites local inflammation and 
pain, then putting the part at rest by strap- 
ping gives the patient relief. Or there is a 
severe bruise causing much pain. Here 
soothing applications, as a piece of folded 
flannel, wrung out of hot water, and freely 
sprinkled with laudanum, or a poultice of 
poppy heads, are good measures to adopt. 
If a sprained joint is very painful, it may be 
swathed in bandages soaked with cold water, 
or cold water allowed to drop on the ban- 



WHAT TO AIM AT. 

When called in to see a patient, the stu- 
dent must expect to find the person acutely 
ill, or thought to be so by those around — 
relations, friends, or neighbors. The first 
thing to determine is, which is the case. 
It is not always easy to do this. How 



12 INTRODUCTION. 



to determine which of the two is the case 
calls out the extent of the practitioner's 
knowledge, and tests the attention he — 
whether a young or an advanced student — has 
paid to the instruction of his clinical teacher. 
If the pulse, respirations, and temperature 
all be over the normal, then organic mischief 
of an acute character is usually afoot. On 
the other hand, there may be collapse or rup- 
ture of an internal blood-vessel without any 
of these. When so called in, do not rush at 
the patient with a stethoscope, but find out 
something about the individual, and then 
proceed to the disease and its amount. It is 
quite as important to know something of the 
patient generally, as it is to determine the 
extent of a pneumonia, for instance. You 
are going to treat the patient rather than the 
disease. You are going to influence the mor- 
bid process in the individual. Above all 
things, keep your head clear and cool, and so 
give your knowledge, be the same more or 
less, a fair chance to exhibit itself. First 
give relief to the patient; then relieve the 
minds of the friends. Make as good an im- 
pression as you possibly can, in order to 
acquire the confidence of the patient and the 
patient's friends, so that they will follow 
your instructions implicitly. The success 
of your plan of treatment will usually turn 
on the thoroughness with which it is carried 
out, and if you do not secure the confidence 
of the patient's friends, j-ou may be pretty 
certain that they will not follow your instruc- 
tions. Never be oblivious of the fact, nor be 
too acutely conscious of it, that the friends are 
examining you while you are examining the 
patient. Bear yourself accordingly, and it is 
better to err, if err you must, on the side of 



ASSIMILATION AND EXCRETION. 13 

excessive care in your examination. Youth is 
apt to be self-confident, and it is very easy to 
make a mistake, even when years have rolled 
over the practitioner's head and taught him 
caution by a painful experience. Be not flip- 
pant then, and carried away with the impres- 
sion that you have arrived at your diagno- 
sis by some inspiration. Be painstaking in 
your examination, and thoughtful in your 
plan of treatment. 



CHAPTER II. 

ASSIMILATION AND EXCRETION. 

It is very important for success in treat- 
ment that the student have some good broad 
views as to assimilation and excretion, for, 
after all, sound physiological knowledge is 
the basis of the practice of physic. Let us 
consider digestion first. Digestion is essential- 
ly a process of solution. Our food is stored 
up in io soluble forms, else a steady rain might 
imperil much of animal life. Starch, then, 
is converted into sugar by a process of hydra- 
tion (that is, the adding of a molecule of 
water) under the influence of the ferments of 
the saliva. This sugar, being soluble, is 
absorbed from the alimentary canal into the 
blood, and then reconverted back in the liver 
into glycogen, or animal starch, by the re- 
moval of a molecule of water. This glyco- 
gen is given off as required into the blood as 
sugar, and is burnt by oxidation, and is 
largely the fuel-food of the body. 

Then the tissue-food, which is albuminous, 
whether as albumen, fibrin, casein, or legu- 
min, is digested by the gastric juice with its 
ferment, pepsin, and is also dissolved by a 



14 ASSIMILATION AND EXCRETION. 

process of hydration, in which the highly- 
insoluble "proteid" is converted into the 
highly soluble "peptone," which readily 
passes through the wall of the alimentary 
canal into the blood. Here it is again passed 
back into a "proteid" by the removal of a 
molecule of water; without such change the 
peptone would as easily escape out of the 
blood as it passed into it. From these albu- 
minoids the tissues are made in growth, and 
repaired in adult life. 

Fat is saponified to some extent by the bile, 
emulsionised by the secretion of the pancreas, 
so that it is taken up by the lacteals of the 
intestinal villi, and thus is brought into the 
system. Fat is not only fuel-food, but is 
essential to the formation of healthy tissues. 

But for solution "disintegration" is essen- 
tial. Before either starch or albuminoids 
can be dissolved by hydration, they must be 
finely divided or disintegrated. For this 
end our teeth are provided. The food 
taken into the mouth is masticated, rolled 
about by the tongue, and mixed with the 
saliva, so that the starch is converted into 
sugar. This action of the saliva ferment, or 
diastase, is arrested as soon as the contents 
of the stomach become acid. Can we do 
anything to aid this part of the digestive act 
when imperfect? Sialogogues, or agents 
which increase the flow of saliva, are not a 
very important class of therapeutic agents. 
All tasty or sapid substances excite a flow of 
saliva, but the medicinal sialogogues are not 
many. Pellitory, jaborandi, and mercury 
are all sialogogues, but are not used as such 
to excite the flow of saliva for the conversion 
of starch into sugar. For this end we use 
artificial diastase, or maltine, produced in 



ASSIMILATION AND EXCRETION. 15 

malting barley. This ferment, diastase, con- 
verts the starch into sugar. And is now large- 
ly used in the feeding of delicate children. 
It should be added to the milk and gruel be- 
fore it is taken into the mouth, not given 
after a meal, to be at once killed by the acid 
contents of the stomach. 

Then as to the digestion of albuminoids. 
Such forms of albuminoid matter as fall 
readily to pieces in the stomach, are more 
digestible than those which are disintegrated 
with difficulty. Thus, loosely-fibred fish, as 
whiting, is much more digestible than close- 
fibred beefsteak. Where there is much pain 
produced by the digestive act, the food, 
when solid, should be such that it is readily 
disintegrated. Pastry and closely-fibred meat 
should be eschewed. False teeth, if neces- 
sary, patience in the act of mastication, 
and properly selected food, are the means 
by which we seek to furnish relief when the 
mechanical obstruction to the digestive act is 
the source of trouble. 

Then as to the solution of albuminoids. 
We do not always attempt to directly stimu- 
late the secretion of gastric juice, though many 
agents will affect that secretion, but now 
commonly use pepsin procured artificially 
from the calf or pig. But we may combine 
these measures. The agents which increase 
the flow of gastric juice are called stomachics. 
They increase the vascularity of the stomach 
and stimulate the flow of gastric juice. Such 
agents we possess in alcohol and arsenic, 
each of which produces inflammation of the 
stomach in toxic doses. Ipecacuan produces 
this vascularity in small doses, but excites 
vomiting in large doses. An old dinner pill 
ran: 



16 ASSIMILATION AND EXCRETION. 

Pulv. Ipecacuan., gr. i. 
Ext. Cinchonae, gr. i. 
Pil. Al. et Myrrh, gr. ii. 

Ringer tells you that an alkali will stimu- 
late an acid secreting surface, consequently 
alkalies may be given before meals, thus : 

Pot. Bicarb., gr. vi. 
Fowler's Sol., njji. 
Inf. Gentian, |i. 

Here is combined the alkali with arsenic 
in a bitter vehicle. 

BITTERS. 

We do not know the action of bitters, but 
we know well empirically that bitters increase 
the appetite and improve the digestion. Those 
containing tannin, as gentian, chiretta, or 
cinchona, etc., should not be given along 
with iron, as they form a tannate of iron 
(ink). Quassia is the bitter to give with iron. 
Quinine is to be used with iron, and not cin- 
chona. 

Then as to the use of artificial pepsin, which 
can now be procured in various forms. Given 
immediately after food, pepsin preparations 
add considerably to the solution of albumi- 
noids when the gastric juice is defective in 
quantity or in solvent qualities. Such, then, 
are the means by which we effect the diges- 
tion of albuminoids. 

Then as to fat. Fat, in the forms of fat, 
oil, and butter, is not acted upon by the 
saliva, nor yet by the gastric juice. When 
the contents of the stomach are thrust through 
the pyloric ring into the gut, they come in 
contact with the bile, and the bile acids 
saponify the fat. Oil will not run through 
filter paper, but when that filter paper has 
been moistened with bile, the oil passes 
through the paper readily. A process of sub- 



BITTERS. 



17 



division equal to disintegration goes on with 
fat before the pancreatic secretion emulsion- 
ises it, so that it can be taken up by the lac- 
teals. Can we do anything to aid this diges- 
tion of fats when defective? We can, by 
seeing that the fat is in a state of fine sub- 
division before it is eaten. Thus, butter well 
rubbed into stale bread, cut thin, is much 
more readily digestible than when spread in 
a thick layer, a fact never to be forgotten 
when delicate children are to be dealt with. 
Then fats vary in digestibility. Cod-liver 
oil is the most digestible of all fats, and can 
often be assimilated when the digestive pow- 
ers are unable to digest other fats. Then 
come cream or butter, or pig fat; solid mut- 
ton or beef suet requiring the strongest diges- 
tive powers. Agents which increase the flow 
of bile, as ipecacuan, or sulphate of soda, aid 
materially in the assimilation of fat; the first 
may be given in pill (see p. 16), the other added 
to the patient's bitter mixture in gss. doses. 



Sod. Sulphat., 3 ss. 
Ac. N. Mur. Dil., TiPvi. 
Inf. Gent., l\. 



will often be found a useful combination in 
simple loss of appetite with impaired diges- 
tive power. We can also stimulate the pan- 
creas by the administration of sulphuric 
ether. The pancreatic secretion not only 
emulsionises fats, but, in an alkaline medium 
digests albuminoids, and converts starch into 
sugar. Consequently we give artificial pan- 
creatic preparations at the end of the diges- 
tive act, to aid the defective action of the 
pancreas, when indicated. 



18 ASSIMILATION AND EXCRETION. 



ARTIFICIAL DIGESTION. 

The digestion of food out of the body is 
now readily attained by the use of prepara 
tions of the pancreas of the pig. Milk and 
water, or milk-gruel, can be digested by pan- 
creatic solutions in the proportion of one pint 
to a teaspoonful of liquor pancreaticus (Wil- 
liam Koberts), and ten grains of bicarbonate 
of soda (in solution). Raised to a tempera- 
ture not exceeding 150° Fahrenheit, the near- 
er this the better, and put under a " cosey " 
for an hour, digestion is then nearly com- 
plete. Such artificially digested food is indi- 
cated in typhoid fever, gastric catarrh, gas- 
tric ulcer and cancer, and in all conditions of 
acute debility, especially when curd from 
plain milk, is found in the stools. 

Then assimilation can never be properly 
carried on if the bowels are loaded. Conse- 
quently always attend to the bowels. Keep 
them open by laxative pills as Pil. Col. Co. at 
bed-time, and, if necessary, a seidlitz powder, 
purgative waters, Carlsbad salts, or, bet- 
ter still, sulphate of soda and Rochelle salts 
(Sod. Pot. Tart.) combined in a warm bitter 
solution. In delicate persons, in all elderly 
persons, and in women at the change of life, 
care must be taken to see that the laxative 
does not gripe, and this may be done by 
adding a carminative, as Pulv. Piperis Nig. 
gr. ii., to the Pil. Col. Co. gr. ii. ; or tincture 
of ginger to the morning mixture. A glass 
of cold water first thing in the morning will 
often suffice to regulate the bowels. Hyos- 
cyamus is often added to the night pill to 
relieve griping (gr. i). 



HAEMATICS. 19 



HAEMATICS. 

Then beyond the assimilation of the differ- 
ent forms of food, i. e., starch, albuminoids, 
and fat, comes that of the different salts of 
lime, soda, potash, and iron. Lime is requi- 
site for the formation of the bones : the blood 
salts for health, as anti-scorbutics, and for 
healthful assimilation, as seen in the effects 
of the profuse night sweats of phthisis, 
where the blood salts are drained away, and 
in the return of the appetite and assimilating 
power as soon as they are arrested. Lime is 
given to children chiefly in the form of phos- 
phate. In malnutrition, lime is largely given 
in the form of phosphites or hypophosphites. 

But of all haematics iron stands first. Iron 

is a tonic when given in full doses, as the old 

tincture of steel TTtx. to iUxx. As a haematic, 

it may be indicated in smaller doses. 

Tinct. Fer. Mur. ; ttex. 
Inf. Quassise, | i. 
Ter in die. 

is a capital tonic. Iron should always, if 

possible, be taken after food, say half an 

hour after; it can then be combined with 

arsenic, strychnine, or quinine. A good 

tonic pill is this : 

Strychnias, gr. i. 
Fer. Sulph. Exsic, 3 ss. 
Pulv. Pip. Nig., i i. 
Pil. Al. et Myrrh, 3 ii. 
In pil. 36 div. 
i. bis in die. 

A gentle action on the bowels is always 
good with a course of chalybeates, especially 
at the start. When iron causes headache, or 
a sensation of heat, it is well to give with 
it a mineral purgative, as 
Mag. Sulph., 3i. 
Cit. Fer. Quiniae, gr. v. 
Inf. Quassise, ? i. 
Ter in die. 



20 ASSIMILATION AND EXCRETION. 

Then a stimulant form is sometimes indicated, 
as in certain anaemic cases with amenorrhoea, 
when the ammonia-citrate is very useful. Or 
it may be required as an astringent in certain 
cases, as in atonic diarrhoea, and the per- 
chloride and pernitrate are both powerful as- 
tringents. 

Tinct. Fer. Pernitr.. Itpxv. 
Inf. Calumbae, § i. 
6ta quaque hora, 

is a good diarrhoea mixture in not very severe 
cases. The form of iron, as a medicine, 
which approaches nearest to the form it 
exists in the blood, is " dialyzcd iron" now 
sold everywhere. Under a course of iron 
the blood becomes richer, the face gains 
color, the patient improves in strength, 
and is lustier. When the anaemia depends 
on a specific poison in the blood, iron must 
be given along with the proper specific, as in 
gout (potash), in malaria (quinine), in syphilis 
(mercury), in lead poisoning (iodide of potas- 
sium;. Certain proportions of soda and 
potash are required for the blood, and nota- 
bly common salt (chloride of sodium), as this 
furnishes the hydrochloric acid for the gastric 
juice, and the soda for the bile salts. The 
buffalo will travel hundreds of miles to get 
salt, and so will certain African tribes. 

There are, however, conditions where iron 
is contra-indicated. It should not be given 
while acute inflammatory conditions are 
present. When the tongue is bare and denu- 
ded of epithelium, it is useless, indeed inju- 
rious, to give iron. When the tongue is 
laden with a thick fur, a layer of dead epi- 
thelium cells, indicative of the condition of 
the intestinal canal, then iron is not absorbed ; 
and it is useless to prescribe it till the tongue 



TONICS. 



is clean. In all conditions of biliary disturb- 
ance, and where lithates are present in the 
water, it is well to withhold iron. 

Water is a haematic in certain circumstan- 
ces. A draught of water on getting out of 
bed in the morning bathes the tissues, 
removes waste material from the body, and 
is an excellent hygienic measure. When 
containing a certain proportion of salts it 
serves this purpose even still more efficiently ; 
and the many palatable drinking waters now 
in vogue testify to the widespread conviction 
of this. Let this be ever borne in mind by 
the youthful reader that dilution with water 
in sufficient quantity is a most important 
matter in courses of alkalies and chalybeat.es. 
The advantage of mineral springs lies in the 
great dilution of the essential factor of the 
spring. The late Dr. Fuller insisted on this 
matter of dilution, and my experience cor- 
roborates his in every respect. Say the pa- 
tient is taking the following mixture : 

Pot. Bicarb., 3ss. 
Ferri Amm. Cit.. gr. v. 
Tinct. Nuc. Vom., TTPx. 
Inf. Quassiae, 1 i. 
Ter in die, 

it will be found that taken half an hour 
before meals with a tumblerful of water, the 
results are much more satisfactory than when 
no rules as to "when" or "how" are laid 
down or followed. Such a mixture is indi- 
cated when the acute symptoms of rheumatic 
fever have abated, and in many forms of 
atonic rheumatism or gout. 

TONICS. 

We are very little wiser as to the modus 
operandi of tonics than Galen was. A tonic 
is an agent which gives tone to the system. 



22 ASSIMILATION AXD EXCRETION. 

Quinine, strychnine, and at a long interval, 
gentian, calumba, and chiretta, are bitter 
tonics. Cascarilla, cusparia, and chamomile 
are aromatic tonics agreeable to the stomach. 
Then the mineral tonics are iron, arsenic and 
copper, chiefly the two first. In convales- 
cence, in conditions of debility, and loss of 
appetite, tonics, and especially the bitter 
tonics, are indicated. So long as the tongue 
is furred, it is well to withhold iron, and to 
give something like this : 

Quin. Sulph., gr. i. 
Ac. Phosph. Dil., njixv. 
Inf. Gentian, ^i. 
Ter in die. 

Or, 

Liq. Strychniae, Tijjiv. 
Ac. Hydrochloric. Dil., Hflx. 
Inf. Cascarillae, |i. 
Ter in die, 

and to act upon the bowels with the measures 
described, p. 18. Under the influence of 
a tonic the appetite improves, the digestion 
gains vigor, and the patient experiences a 
sensation of energy dependent upon a feeling 
of well-being. How far tonics act specially 
on the centres of the respiration and the cir- 
culation is not yet definitely known. Proba- 
bly tonics act on all nerve-centres, some act- 
ing more on some, others on other centres. 

EXCRETION. 

To comprehend excretion correctly, the 
student must grasp the subject from the 
point of view of evolution. In the little jelly 
speck, the amoeba, the tiny particle of food 
is seen to disappear by a digestive act which 
entails no special organs. As life advances 
upward, we find an alimentary canal form- 
ing, and upon this a liver, etc., become devel- 
oped. But all organs with ducts are but por- 



EXCRETION. 



23 



tions of the general excretory surface ; more 
specialised areas still possessing the charac- 
ters of the primitive exterior. Consequently 
we find that in conditions of jaundice, the 
bile is not excreted by the bowels, as it is 
normally, but by the kidneys, for the urine 
will leave a deep bile stain on the linen; or 
by the mammary glands, the milk also stain- 
ing any object with which it comes in contact. 
In conditions of arrested action of the kidneys 
we may have, and commonly do have, urae- 
mic diarrhoea, and even ureous vomiting, 
while the breath has a urinous odor. "When 
the action of the kidneys is arrested or defec- 
tive, other excretory organs take up the 
work, eliminating the nitrogenised waste. 
The kidneys are involutions of the skin, and 
in scarlet fever, when the cuticle is shed, 
there is very frequently "desquamative ne- 
phritis." Recent observations have demon- 
strated that in the presence of urea, uric 
acid, the phosphates, chlorides, and sulphates 
of the alkalies, the constituents of sweat, are 
those of urine. Even carbonic acid, which 
is usually supposed to be given off by the 
lungs only, is exhaled from the skin. In the 
lower animals, cutaneous respiration is in- 
deed an important matter. The practical 
utility of remembering the common origin of 
the excretory organs lies in the fact, that other 
organs can help out special organs when 
functionally disabled. Thus in acute nephri- 
tis, we put the bowels into energetic action 
with cathartics, and excite the skin by hot 
baths, till the patient sweats freely, and so 
relieve the kidneys. Not uncommonly diar- 
rhoea is a compensating action, not a disease 
per se. The first patient seriously ill when I 
took my father's practice, I killed. She was 



24 ASSIMILATION AND EXCRETION. 

the subject of chronic Bright's disease, of 
which I was not aware, and had severe diar- 
rhoea, which, after much difficulty, I succeeded 
in arresting by the usual combinations of 
astringents and opiates. Bnt instead of im- 
proving, when the diarrhoea was checked, in 
a few hours the patient grew worse, and soon 
went into ursemic coma, which proved 
quickly fatal, the breath producing grand 
crystals of hydrochlorate of ammonia on a 
microscopic slide moistened with dilute hy- 
drochloric acid. I fully realized what I had 
done, and was very sorry for the poor far- 
mer whose wife was thus removed, but my 
regret did not and could not restore to him 
his wife, however much I might take the 
matter to heart. But the lesson it taught 
me will never be forgotten, and the avowal of 
it here may put many a student on his guard 
in similar cases. Since then I have made it 
a rule, in all cases of diarrhoea where there 
is any suspicion of kidney mischief, not to 
attempt to check the diarrhoea, except by 
food, until the other excretory actions are set 
agoing. Chronic skin affections of a gouty 
character are very common in chronic renal 
disease, and are curable only by measures 
which strike at the casual disturbance, name- 
ly, accumulation of nitrogenised waste in the 
blood. 

This nitrogenised waste may take the form 
of either bile acids or uric solids, and either 
circulating in the blood gives rise to much 
disturbance. Very many of the maladies 
met in practice are not associated with lesions 
readily recognizable in the dead-house, and 
of these the troubles associated with excess 
of waste form a large proportion. For the 



EXCRETION. 



25 



treatment of these maladies we use a class of 
agents called alteratives. 



ALTERATIVES. 

"These may, perhaps, neither stimulate 
nor depress, so far as can be perceived, any 
function of the body; their action may be 
silent and imperceptible, their mode of influ- 
ence may be unknown, but their therapeutic 
effects are among the most assured of clinical 
facts." (H. C. Wood). So far experimenta- 
tion has thrown little light upon these agents, 
but clinical experience is rich as to their 
utility. Mercury is a powerful alterative, 
especially useful when the retrogade changes 
in albuminoids are not going on satisfactorily. 
It seems t© facilitate the oxidising processes 
requisite for their -removal. Arsenic acts 
upon all the excretory organs, and is a power- 
ful alterative of a tonic character, often most 
useful in cases of malnutrition with consoli- 
dation of one or other lung apex. The use 
of arsenic by the Styrians to give them good 
"wind" and a ruddy countenance is well 
known. Then iodide of potassium is a favor- 
ite alterative. "Donovan's solution," a com 
bination of iodine, mercury, and arsenic, is a 
powerful alterative, not as much used as it 
might be. Then in many cases the alkalies 
are very useful in the removal of excremen- 
titious nitrogenised material. The value of 
mercury as an alterative is vividly shown in 
the following case, very common in practice. 
A person has a foul-coated tongue, a bitter 
taste in the mouth, and general malaise, with 
more or less headache. Vegetable purgatives 
are taken until free purgation is induced. 
Yet the condition is little relieved, if at all. 
A mercurial pill is prescribed at bed-time. 



26 ASSIMILATION AND EXCRETION. 

and an alkaline saline purgative in the morn- 
ing; and, presto, the tongue cleans and all the 
unpleasant sensations pass away with the bile 
laden stools so induced. This is a subject 
which attracts very little attention in hospi- 
tals, and especially teaching hospitals; but 
it is one of considerable importance in daily 
practice. An alterative is an agent which 
is given off by the different excretory sur- 
faces, and probably stimulates their activity, 
and so alters the condition of the system. 
" To deny the existence or value of medicines 
of this class because we cannot tell why mer- 
cury relieves syphilis, or why iodide of potas- 
sium cures rheumatism, is as absurd as to 
deny the existence of the syphilitic or rheu- 
matic dyscrasia, because we do not know 
their ultimate nature." (H. C. Wood). As 
to how to use these alteratives, a few illus- 
trations may be given. Thus in rheumatic 
pains it may be well to prescribe 

Pot. Iod., grs. v. 
Pot. Bicarb., 3ss. 
Inf.'Buchu, 5i. 
Ter in die. 

If there be any deposits in the urine, it 

may be well to give Pil. Cal. Col. Co. gr. iv. 

every second night. Or in a case of chronic 

syphilis 

Liq. Hyd. Bichlor., 3 i. 
Tinct. Fer. Mur., Tlftx. 
Inf. Quassise, § i. 

would be a good prescription. Iron given 
along with mercury prevents the cachexia 
which large doses of mercury taken contin- 
uously are apt to produce. And it is a most 
important matter to remember in the treat- 
ment of constitutional syphilis, that iron ad- 
ministered with mercury obviates the ill 
effects which the mercury alone is apt to 
produce. 






EXCRETION. 27 



Or a person is suffering from a chronic con- 
dition of imperfect health, as, for instance, a 
girl at puberty, who is pale and listless, and 
"good for nothing," and in whom the cata- 
menia are not being properly established. 
Here there is probably constipation, and 
aloes is both a purgative and a stimulant to 
the hemorrhoidal vessels which supply the 
uterus. Consequently 

Arsenic, gr. ij. 
Fer. Sulph. Exsic, 3 i- 
Pulv. Pip. Nig.. 3 iss. 
Pil. Al. et Myrrh, 3 ij., m. ft. 
In pil. 60 div., 

one to be taken twice a day after meals, 
would be a good measure to adopt. Here 
the chalybeate is given with an alterative and 
a laxative, and in a few weeks probably the 
patient will be much relieved. Such a pill 
is also excellent where there is general mal- 
nutrition, with consolidation of one or both 
lung apices, especially when the night-sweats 
have been arrested. At the commencement 
of a severe cold, it is well to give as an alter- 
ative combined with a sudorific 

Cal., gr. iv. 

Pulv. Antimonial., gr. v., 

at bed time, and a black draught, or seidlitz 
powder in the morning; and after that 

Pot. Iod., gr. iv. 
Liq. Amm. Acet., 5i. 
6ta quaque hora. 

By giving the powder the night before the 
morning purgative, the reparative processes 
will be aided and expedited. I did not be- 
lieve this in my early days, but a little expe- 
rience soon convinced me on the matter. In 
strumous children the addition of iodine to 
iron is excellent, as seen in the Syr. Ferri. 
Iod. 



28 BODY TEMPERATURES. 

It is, however, not till he gets "into prac- 
tice " for himself and feels the pressure of 
the competition for an existence, when pa- 
tients are something more than mere social 
units (as they are in a student's eyes in a 
hospital out-patient room), that the young 
medico is likely to take any interest in alter- 
atives, or to appreciate their utility. 



CHAPTER III. 

BODY TEMPERATURES. 

The temperature of the body in health is at 
or about 98-5° Fahr., and this is maintained 
alike in Arctic regions, and in hot countries 
where the surrounding temperature varies 
greatly. The student should have a clear idea 
of the production and dispersion of heat in 
the body, in order to wield his clinical ther- 
mometer skillfully, and to interpret correctly 
the information it furnishes. 

The body heat is produced by the union of 
carbon and hydrogen with oxygen, in the vis- 
cera and the muscles ; and, to a small extent, 
by the oxidation of albuminoids, chiefly in 
the liver. Heat is radiated from the body by 
the cutaneous, or heat-losing area; chiefly by 
the cooling effects of the evaporation of water, 
i. e., by insensible perspiration. The more 
the blood is in the internal, or "heat-produc- 
ing " area, the more body -heat is evolved ; 
while increased vascularity in the skin in- 
creases the heat loss. In a cold temperature, 
the skin is cool and marbly, and devoid of 
sensible perspiration ; in hot climates the per- 
spiration is very profuse. Violent muscular 
exertion induces sensible perspiration, and 
thus increased heat production is accom- 



BODY TEMPERATURES. 



panied by increased heat loss. Again, if a 
draught of iced fluid is swallowed, while the 
person is very warm, sensible perspiration is 
experienced almost immediately. The cold 
fluid contracts the blood-vessels of the inter- 
nal area, the warm blood is driven to the 
surface, and then ensues perspiration, which 
of course increases heat loss ; and so we feel 
more comfortable. If the student will bear 
in mind these physiological facts, he will more 
clearly comprehend — and this is, in practice, 
a very important matter — the difference be- 
twixt a pyretic condition with a " dry " skin 
and one with a "wet" skin. 

Let me try to make this quite plain to the 
youthful reader. When the skin is " wet," it 
is obvious that the heat loss must be great, 
and considerably above the normal. It is 
quite clear then that the heat production must 
be very great for pyrexia to be maintained 
with a wet skin. On the other hand, in ordi- 
nary pyrexia, as at the beginning of a com- 
mon cold, or in the early stages of the exan- 
themata, and in typhoid fever, the skin is dry 
and imperspirable, and thus there is little heat 
loss by evaporation. Of course there is a 
certain heat loss from the hot vascular skin ; 
but as the cooling effects of evaporation are 
the chief factors in heat dispersion, which is 
unequal to the heat production, the body heat 
accumulates and a state of "fever" is insti- 
tuted. Now it is quite clear to the student, 
that his line of treatment in the first case, is 
not to attempt to increase "heat-dispersion," 
but to limit "heat-production." In the sec- 
ond case, increased ' ' heat-dispersion ' ' is es- 
sentially the matter to be aimed at. How 
then are these ends to be attained ? I will 
try to tell. 



30 



BODY TEMPERATURES. 



Depressants, or remedial agents which 
lower activity in the body processes, are of 
two classes, (1) nerve depressants, and (2) vas- 
cular depressants. The agents which will de- 
press nerve-activity will be considered further 
on (Action and Inaction). 

VASCULAR DEPRESSANTS. 

A vascular depressant is an agent which 
lowers the heart's activity, and this affects 
the production of body-heat, first by slowing 
the blood-current, lowering the blood-pressure 
in the arteries, and so limiting the oxidising 
processes in the lungs and elsewhere. Thus 
it strikes directly at heat-production. This 
would, however, not be very efficient if at 
the same time these agents did not act on the 
peripheral vessels. These agents also dilate 
the cutaneous vessels, and so increase heat 
loss; not only that, but they act upon the 
sudoriparous glands and induce perspiration, 
which had previously been arrested, and thus 
directly increase heat dispersion. These 
agents are antimony and aconite, par excel- 
lence. Chloral hydrate and opium (potent 
nerve-depressants) also lower heat production 
and increase heat dispersion. Now let us see 
how these agents can be made useful in the 
treatment of pyrexia. Say the student is 
called to a case of severe cold, with tumes- 
cence of the lining membrane of the respira- 
tory tract. The skin is hot and dry; the 
patient is feverish and thirsty. He is drinking 
cold fluids, which, in being raised to the 
body temperature, neutralize so much heat. 
Here it is evident that heat dispersion is what 
is required. To restore the action of the su- 
doriparous glands will at once give relief. So 
it is well to give 



BODY TEMPERATURES. 31 



Pulv. Opii.,gr. i. 

Pulv. Antimonial., gr. v. 



for an adult, at bed-time. This will probably 
provide a fair night's rest; then something of 
this kind may be prescribed : 

Vin. Antimonial., TTJlxx. 
Liq. Am. Acetat, I i. 
6ta quaque hora, 

the first dose to be taken early in the morn- 
ing. Some half-hour after it is taken, give 
the patient a draught of hot fluid, as milk, 
beef tea, weak tea or coffee, or cocoa. Per- 
spiration is most easily and readily excited 
about 6 or 7 a. m. , as a phthisical patient can 
tell you. Repeat this the next morning. The 
effect of this line of treatment is to make the 
skin moist, and so aid heat dispersion; to 
make the pulse soft, and so to lessen the vas- 
cular turgescence of the congested mucous 
lining of the air passages ; and with this low- 
ering of the turgescence, secretion" is restored, 
and the mucous membrane is soothed thereby. 
There is less irritative cough, and the expec- 
toration is easier. The cough set up by the 
irritation caused by the congestion and dry- 
ness was useless and exhausting. Now it is 
less, but it is accompanied by expectoration. 
This action may be facilitated by the inhala- 
tion of steam, or, still better, the fumes from 
a large sponge, wrung out of hot water, on 
which a tablespoonful of turpentine has been 
dashed. Or a large bucketful of water may 
be placed on the floor of the room, if the 
patient be a child — for children cannot readily 
be taught to inhale. So much for the treat- 
ment of a common cold. 

[Hot bricks placed in water is a very con- 
venient method of generating steam for the 
sick-room.] 



32 BODY TEMPERATURES. 

* 

If the patient is a child of twelve with 

measles coming on. Here again is a fast 

pulse, a dry skin, and rising fever. The 

tongue is furred, and it may be necessary to 

prescribe 

Cal., gr. iii. 

Pulv. Jalap, gi . V'. 

at bed- time. But the main treatment would 

be to prescribe 

Vin. Antimon., 

Vin. Ipecacua !., a" ttjjx. 

Aq. Anethi, 3 ij. 

4ta quaque hora, 

which would keep down the pyrexia pretty 
well. Or aconite may be used after the plan 
advocated by Sidney Ringer. 

Tinct. Aconiti., Tini. 

every hour. But perhaps it would be more 
convenient to prescribe 

Tinct. Aconit, Ifl) iv. 
Vin. Ipecac, M x. 
Aq. Anethi. 3 ii. 
4ta quaque hora. 

But the student must never forget that children 
bear depressants badly,£ e. , ordinary doses will 
at times produce alarming prostration ; so he 
must be on his guard in this matter.. On the 
other hand, children are tenacious of life. 

Or a patient has typhoid fever. Thirty 
years ago he would have been dosed with anti- 
mony ; fifty years ago he would have been 
bled; now most likely he is put in a cold wet 
sheet, or placed in a bath of water at 95° 
Fahr. , and cooled down. The bleeding would 
affect the heat-producing processes, by the 
abstraction of a number of the red blood- 
corpuscles — a very direct means of striking 
at the pyretic state. One of the best and most 
skilful general practitioners I know, practises 
in a country district with a hardy rural popu- 






lation around him. He always carries his 
lancet-case with him, and in rising pyrexia 
from a local inflammation, usually commences 
his treatment by a moderate bleeding. His 
experience tells him that these persons bear 
bleeding well; and after this depletion, the 
medicines he prescribes act more efficiently 
than where no bleeding has been practised. 
The rational, intelligent use of the lancet 
must come in again. To return to the typhoid 
fever patient. He should be kept in bed in a 
well ventilated room; his stools should be 
carefully disinfected the moment they are 
passed, and at once removed from the sick 
chamber and buried; he should be fed on 
milk essentially ; but if ' this curd too much, 
the milk had better be diluted with water, and 
some form of farina added, to prevent a firm 
curd forming in the stomach. When the 
milk curds too firmly, the white curd is seen 
in the pea-soup coloured stools. Such is the 
management of the case so far. Now, what 
should be given to the patient as medicine ? 
If the case is a mild one, it is customary to 
let it alone and watch it, or perhaps give 
some mineral acid, as phosphoric or hydro- 
chloric, well diluted with water. 

Acid. Phosp. Dil., ttexv. 
Syr. Simplic, 3 i. 
Aquae, 3 ii. 

6ta quaque hora. 

would be pleasant and refreshing to the pa- 
tient, to say the least of it. But my own 
private opinion is that the acid to be used 
here is essentially the hydrobromic. There 
is a tendency to cerebral excitement and de- 
lirium at nights, which is aggravated by 
opiates. Bromine is a nerve sedative of a 
potent character, as the extensive use of the 



34 BODY TEMPERATUBES. 

bromides testifies. If I were directing the 

treatment of typhoid patients, the hydro- 

bromic acid would be freely used. It is as 

pleasant an acid as any other, and is sedative 

to boot. 

Ac. Hydrobromic, TTflxx. 
Syr. Simplic, 31. 
Aq- ?j. 

every four or six hours, would be the mixture 
employed 

If the case be pyrexia associated with local 
inflammation, the student must look to two 
separate matters: (1) the position and extent 
of the local inflammation ; and (2) the general 
disturbance of the patient. Patients of the 
phlegmatic order often show little general 
systemic disturbance, even with extensive in- 
flammation. Those with a mobile tempera- 
ment will manifest much general perturbation 
from a slight cause. It is well to appraise 
each factor carefully. In the nervous person 
it would be well to use chloral hydrate in 
small doses, often repeated. 

Chloral Hydrat., gr. x. 
Mist. Camphorae, | i. 
6ta quaque hora, 

would probably produce satisfactory results, 
[f the pain is great, as when a serous surface 
is inflamed, the analgesics are indicated as 
well as depressants. Say it is a case of pleu- 
risy in a fairly strong man. Then 

Tinct. Opii, ll^xx. 
Via. Antimon., ffijxv. 
Mist. Camphor., §i. 
6ta quaque hora, 

is my favorite mixture. But here crops up 
the question of the local treatment, a matter 
we had not to deal with before. Here is the 
dry inflamed pleurae rubbing on each other at 
every respiratory movement. This produces 



BODY TEMPERATURES. 35 

the acute pain requiring the opiate. To re- 
lieve this some leeches may be used to deplete 
the costal pleura; or it might be well to at- 
tain the same end by a hot poultice. Here the 
dilation of the cutaneous twigs of the inter- 
costal arteries depletes the pleural twigs and 
so furnishes relief. But there is another mat- 
ter to be attended to, and that is — rest of the 
inflamed part. Putting a flannel binder round 
the chest, and so limiting the thoracic move- 
ment in the respiratory act, lessens the pleural 
friction which is the source of pain; the 
respiration being thus made almost entirely 
abdominal. A large poultice both depletes 
the costal pleura and limits movement; con- 
sequently it is always well in pleurisy to order 
one. • 

In peritoneal inflammation opium should 
be given freely and boldly. The more severe 
the pain, the larger and more frequent should 
be the dose of the opiate ; while the belly 
should be covered by flannels wrung out of 
hot water and freely sprinkled with turpen- 
tine and laudanum. During acute pain of 
inflammatory origin, push opium freely; 
withdrawing it as the pain subsides. 

"We now come to the subject of pyrexia 
with a "wet skin." This is very commonly 
seen within a week or two of parturition ; but 
is also seen under other circumstances. The 
body temperature is high, and the heat dis- 
persion from the moist skin is considerably 
more than the normal heat loss in health ; con- 
sequently there is a very great heat produc- 
tion. But it is useless to attempt to meet 
such pyrexia by any means of heat dispersion 
— unless it be that of external cold— so we 
must look to something else. Extensive ex- 
perimentation on the Continent has demon- 



36 BODY TEMPERATURES. 

strated the utility of quinine, and of digitalis, 
in lowering the body temperature in condi- 
tions of pyrexia. Quinine is believed to in- 
terfere with the oxydising processes and so to 
arrest pyrexia. Digitalis acts by contracting 
the peripheral arterioles which are dilated in 
pyrexia. (It is a law that the blood pressure 
in the arteries and the body temperature stand 
in an inverse proportion to each other. 
Digitalis increases the ventricular contrac- 
tions, contracts the arterioles, and thus fills 
the arteries). We cannot regard the explan- 
ations so far attempted of the action of quin- 
ine or digitalis as quite satisfactory ; but their 
value clinically is established beyond ques- 
tion. The following combination has done 
me yeoman service on numerous occasions. 

Quinise Sulph., gr. v. 
Tinct. Digitalis, 
Ac. Phosph. Dil., aa njlx. 
Aq. li. 

4ta quaque hora. 

It should be given at longer intervals as the 
pyrexia defervesces. Our knowledge of quin- 
ine and digitalis as anti-pyretics is in its in- 
fancy; while experience is too conflicting 
about salicylic acid for anyone to attempt to 
appraise its value as an anti-pyretic. 

Low Temperatures. — In the treatment of 
low temperatures we can use heat, either ap- 
plied externally, or, as hot fluids, taken in- 
ternally. A hot poultice over the heart will 
always stimulate its action. If a lo*w tem- 
perature is not the result of disease of the 
lungs or heart, it may be due to alcoholic in- 
toxication, or to the effects of opium, chloral, 
aconite, or other toxic agent, which kills by 
bringing the circulation and the respiration 
to a standstill. The temperature falls as these 
vital actions are arrested; while the fall of 



INFLAMMATION. 



37 



temperature further paralyses their enfeebled 
centres; and so life is extinguished. Medi- 
cinally the best agent to employ is belladonna, 
which increases body heat and excites both 
the circulation and the respiration. It should 
be given in the form of atropine, which is 
tasteless, the dose of which can be carefully 
measured. Belladonna has an unpleasant 
taste, and all galenical preparations of it are 
of uncertain strength. It may be given 

Am. Carb., gr. iv. 
Liq. Atropiae Sulph., tth i. 
Aq. Menthse," ?i. 
4ta quaque hora. 

Such a combination I find most useful in cases 
of chronic bronchitis and emphysema, where 
there is a strong tendency to a low tempera- 
ture. If the case were urgent, as in alcoholic 
poisoning, my own plan would be to inject 
subcutaneously thirty minims of the Liq. 
Atropiae. On Feb. 14th, 1878, I had a grain 
of sulphate of atropia injected, at once, into 
the arm of a woman who was dying from 
opium poisoning, with the most satisfactory 
results. In the United States atropine is 
used for the treatment of collapse, with such 
results that this use of it is extending. Its 
use is indicated in the collapse due to burns. 



CHAPTER IV. 

INFLAMMATION. 

Inflammation may be acute or chronic. As 
the first it is commonly seen as pneumonia, 
as inflammation of a serous or mucous mem- 
brane, or of the bones or rather periosteum. 
It occurs in the latter often in a subacute or 
chronic form. As chronic inflammation it is 
well seen in the valves of the heart, which 
are commonly the seat of chronic changes. 



38 INFLAMMATION. 

The student has been taught that inflamma- 
tion is not merely vascular congestion — it is 
vascular congestion, and something more, 
viz., a production of cell growth, to speak 
broadly. Inflammation of a serous membrane 
is commonly followed by a fluid accumulation 
in the serous sac, which has to be dealt with 
in its turn. The pathology of inflammation 
must not detain us, however. 

In inflammation of any area, large or small, 
the minute blood vessels of the affected area 
are dilated, while the nutrient arteries are 
full and dilated. (A patient of mine has ec- 
zema of the scalp ; when the eczema is active 
his temporal artery can be seen pulsating dis- 
tinctly.) This is accompanied in ordinary in- 
flammations by a state of general high arterial 
tension ; so that there is an abnormally large 
quantity of blood in the affected part. We 
can attack this condition of the vascular sys- 
tem by the measures mentioned in the pre- 
ceding chapter. We know of no agents 
which will directly affect the inflamed part, 
but we can often afford direct relief. For 
instance in a phlegmon we can put on leeches; 
or in a whitlow abort the suppuration by an 
incision into the inflamed parts, without wait- 
ing for suppuration. But in glandular in- 
flammations we try other measures than in- 
cision; for instance, in a bubo we put on a 
lead and opium lotion, and when all tender- 
ness is gone, paint it with iodine to promote 
absorption. In the preceding chapter the 
treatment of pleurisy was described. The 
agents which lower blood pressure in the ar- 
teries and also promote perspiration (and con- 
sequent heat dispersion) allay pyrexia. But 
by lowering the blood pressure in the arteries 
generally we lessen the vascularity of the in- 



INFLAMMATION. 89 

flamed area, i.e., less blood is driven into it 
in ' ' sthenic " inflammation, the form now 
spoken of. If the patient has a full, rapid 
pulse and a high temperature, from a thera- 
peutic point of view, these two matters are 
more important than the seat of the inflam- 
matory aetion, or even its extent. To lower 
the blood pressure is to "starve " the vascular 
zone. Antimony, aconite, and other depres- 
sant agents have been used for this end ; and 
it is not "bad practice" in the country to 
commence by letting a little blood, six to ten 
ounces, or so. 

If the patient is in acute pain, analgesics 
must be administered. If the patient has a 
hot head, flushed eyes, sharp pulse, and rolls 
the head about in agony, you would diagnose 
meningitis and give 

Pot. Brom., 
Chloral Hydrat., aa 3i. 
Mist. Camph., \i. 
4ta quaque hora. 

increasing or decreasing the dose according as 
the symptoms deepened or were relieved. 
Then you would put cold to the head, as 
pounded ice and salt, or cloths saturated with 
eau de Cologne, or vinegar and water. In- 
stead of bleeding, you would probably find 
it more convenient to use a brisk cathartic, as 

Elaterii, gr. 1-12. 
Pulv. Scam. Co., 3i. 

Copious watery stools take a quantity of 
water from the blood, and so deplete an in- 
flamed area. Opium is not good in inflam- 
mations within the cranium or thorax; but 
below the diaphragm, and in inflammations 
in the limbs, it is invaluable. 

[In many cases hot applications to the head 
and back are much better than cold in cere- 
bro-spinal meningitis.] 



40 INFLAMMATION. 



If it is a case of pneumonia, it may be well 

to prescribe 

Vin. Antimonial., llflxx. 
Liq. Am. Acetat., $ i. 
6ta quaque liora. 

To put on a large jacket poultice, and so to 
dilate the vessels of a large cutaneous area, 
is "to bleed the patient into his own vessels " 
pretty effectively; or aconite might be used. 
If, however, the patient be seen when the dis- 
ease is far advanced, and the danger immi- 
nent, death must be averted if possible. The 
patient is pale, the respiration is very rapid, 
the pulse weak and thread-like — the patient, 
indeed, is dying with pulmonary engorge- 
ment and a right heart distended nearly to 
paralysis ; and where the right heart is throb- 
bing and palpitating in its attempts to carry 
on its work, then try to keep the heart and 
respiratory muscles at work, and combine di- 
rect stimulants to the respiratory centre, as 
ammonia, and strychnine, with a distinct 
stimulant to the cardiac centres, as digitalis: 

Am. Carb., gr. v. 
Tinct. Nuc. Vom., 
Tinct. Digitalis, aa HEx. 
Aq. $i. 
4ta quaque hora. 

It would not alter the therapeutic line of 
attack whether the case was one of pneu- 
monia, simple or tubercular, bronchitis, or 
capillary bronchitis ; you really treat the dis- 
ease through the patient. Your distinct busi- 
ness is to avert death. The above combina- 
tion has done me great service many a time, 
and will do so for you too, if given at the right, 
time and place. Never mind antiquated text- 
books; when you have passed from the ex- 
amination table to the bedside of your own 
patients, you will soon find that much 



INFLAMMATION. 



41 



required for the first is of precious little ser- 
vice at the bedside ; and further, the painful 
discovery will dawn upon you that what is 
required for everyday practice has almost en- 
tirely to be acquired after your educational 
course is ended. 

When you have ' ' sthenic " inflammation 
to deal with, the indications are (1) to relieve 
pain; (2) to lower the vascular activity, gen- 
erally and locally ; (3) to lower the tempera- 
ture — these two are attained by the use of de- 
pressants; and (4) to keep the stomach and 
alimentary canal in good order. If unfortu- 
nately the stomach gets upset, you must in- 
stantly "change your front," to use a mili- 
tary expression. Never treat the stomach 
with disdain. Compromise with it you must. 
Other measures, no matter what they are, 
must be suspended, and the stomach treated 
when irritated. 



Pot. Brom. 3j. 
Mist. Bism. Alk., 5i. 
6ta quaque hora, 



may be tried if sickness supervene. If the 
stomach be acid, add to the milk taken a suffi- 
ciency of prepared chalk, or magnesia, to neu- 
tralize the acidity, and prevent the milk curd- 
ling too firmly. If the tongue is raw and de- 
nuded of epithelium, stick to this line with 
might and main — to the exclusion of all else, 
viz., to keep the stomach in good humor. 
If the tongue is foul, a calomel and colo- 
cynth pill at bed-time, and an ounce or so of 
black draught, will often do good. But whe- 
ther you flog on the vital centres of respira- 
tion and circulation, or you attend to the 
stomach, of course turns on the exigencies of 
each case. You must use your own judg- 
ment in every case, or get some wiser head to 



42 INFLAMMATION. 






tell you. As long as life is not very seriously 
threatened, keep a steady eye on the condi- 
tion of the tongue. 

"Asthenic" , inflammation is common 
among our city population: ill-bred, ill-fed, 
the blended products of drink, poverty, lust, 
and syphilis; reared on tea with a dash of 
alcohol; a race deteriorated in physique by 
inheritance and wrong rearing, our city -bred 
patients of the lower class almost never need 
depressants. They bear them badly. The 
quinine and digitalis mixture above is in- 
finitely better for them. They need alcohol 
in liberal quantities; they are accustomed to 
it ordinarily, and need extra large doses in 
disease. They have very little "margin of 
health," and little or no physiological capital 
to fall back upon to enable them to resist the 
stroke of acute disease. You must feed them, 
and give tonics. The fluttering pulse and 
heightened respiration require 

Am. Carb., gr. iv. 
Inf. Cinchonae, | i. 
4ta quaque hora, 

or they sink, or the combination with atro- 
pine is indicated at an early stage. If an in- 
flammation in them does, at an early stage, 
present " sthenic" symptoms, they soon pass 
away, as a rule, and give place to "asthenic " 
symptoms. Depressants they will quickly 
sink under — a moderate dose of chloral if 
sleepless — and all call for further medical 
interference is abruptly ended. In others, 
especially persons of broken health and shat- 
tered constitutions, drunkards, or debauchers; 
or with constitutions sapped by overwork, 
syphilis, or struma, the same tendency to 
rapid failure of the vital powers is experi- 
enced. I can not and do not profess to put 



INFLAMMATION. 



43 



an old head on young shoulders; but I can 
tell the student what he has to try to do. It 
will depend much on his own willingness to 
learn as well as his intelligence, how far he 
profits by what I write. Students are apt, at 
times, not to look straight at facts, but to 
quibble, to argue for argument's sake; to de- 
liberately close their minds against the ingress 
of information, and then of course they are 
no longer teachable, but harden themselves 
in ignorant skepticism — a very bad mental 
attitude to adopt! After the brunt of the 
inflammatory action has been withstood 
successfully, and the acute symptoms are 
over, then comes the " wreckage of the storm" 
to be dealt with. If the tongue cleanse satis- 
factorily, then something of this kind is 

indicated : 

Quin. Sulph., gr. i. 
Ac. Phosp. Dil. lip xv. 
Inf. Gentian. | i. 
Ter in die ; 

or five drops of the liquor strychnia may be 
substituted for the quinine. If there be a 
quantity of lung consolidation remaining, a 
thickened pleura, or peritoneum, a mercurial 
will often be of signal service. Inflam- 
matory products, syphilitic growths, like 
the spare albuminoids (the luxus consumption 
of the Germans) become so altered by the 
action of mercurials that they are readily got 
rid of. The fact we know; the explanation 
of it is shrouded in "the darkness that pre- 
cedes the dawn." If there be pleuritic or 
pericardial effusion, a blister will often lessen 
the bulk of fluid and "promote absorption." 
Here, too, an occasional mercurial is often 
useful ; but be careful to see that tonics and 
chalybeates are also administered to weak 
patients. 



44 



INFLAMMATION. 



The lines laid down here for the treatment 
of inflammation apply to strictly surgical 
cases. The medical aspect of surgical cases 
requires more attention than is at present 
accorded to it. In osteitis and periosteitis, to 
allay pain, to lower vascularity, and to pro- 
mote sleep, are often as important matters as 
the local surgical measures. Where a surgi- 
cal measure has given systemic relief, little 
or no medical treatment may be required. 
But before this, or when the relief afforded 
is partial, medical measures may be of the 
greatest value; and it is not wise to overlook 
them. 

Best may be of the most essential service. 
In inflammation of a joint we recognize this, 
and secure rest. We strap a thorax in 
pleurisy when a broken rib is rubbing the 
pleura into inflammation; or when a tubercle 
protrudes from the lung and produces the 
same result. But in the treatment of- endo- 
carditis this has been utterly forgotten. Yet 
when an inflammatory storm is passing over 
the valve-curtains of the heart, lighting up a 
growth of connective tissue corpuscles in the 
fibrous structures beneath, we forget the 
lessons of pathology. The greater the strain 
upon the valve-curtains, the greater will be 
the growth of these corpuscles, whose ulti- 
mate contraction will distort and mutilate 
the valves. Keep the patient flat on the back 
for days after the active symptoms have 
passed away; what is a week in bed to a 
crippled existence with a leaking or stenosed 
mitral valve? Calm the circulation, and the 
nervous irritability and desire to be getting 
up, with chloral if necessary. To use meas- 
ures to give tone to the circulation, to throw 
more strain on those valve-curtains by getting 



INFLAMMATION. 45 

the patients up, is unreasoning, mischievous 
energy. It is enough to make one despair of 
the reasoning power of the species to think 
of the treatment of rheumatic fever with 
endocardial complications, after the acute 
symptoms are over. The lessons of pathology 
so carefully conned in the dead-house are 
forgotten at the bed-side ; and the light they 
should project to guide our steps in practice 
is curiously wanting or neglected. 

Parenchymatous Inflammation. — Still 
more necessary is it to remember the lessons 
taught by pathology in those chronic modifi- 
cations of nutrition now called parenchyma- 
tous inflammations. ' Habitual use or over- 
stimulation of a part, by producing deter- 
mination of the blood to it, may readily drive 
it into inflammation,' writes Erichsen. The 
knowledge of this fact teaches us to lessen 
that demand upon the part which is driving it 
to inflammatory changes, and so avert the 
danger. This is often more efficient than 
medical treatment. ' The whole origin and 
course of the parenchymatous inflammation 
must be subjected to a birdseye view, and 
then each part of the whole seen in its true 
relation to the rest. At the same time each 
part should have special attention given to it 
and its needs. If it be interstitial pneumonia 
in a mason working on fine stone, he must 
leave his occupation and flee for his life. As 
a police officer, a soldier, or an emigrant, he 
may live; but if he remain a 'fine-hewing' 
mason, he will surely die; and that before 
long too. If the striker or boatman on the 
first evidences of aortic valvulitis quit his 
occupation and take to some lighter form of 
labor, he may live to a fair length of days. 
But if he adhere to what has produced 



46 



INFLAMMATION. 



disease in healthy organs, the morbid pro- 
cesses will be aggravated and the end acceler- 
ated. If the gin-drinker reform, his injured 
liver may last for years. If the gouty man 
reduce his consumption of nitrogen to what 
his kidneys, aided by his skin, can fairly 
eliminate, length of days may not be ab- 
solutely out of question ; but such prolonga- 
tion of life is incompatible with self-indulg- 
ence. Aortic valvulitis is common in ham- 
mermen or strikers, boatmen, and others wlie 
make sustained severe efforts, and thus throw 
strain upon the aortte valves; indeed, it is not 
a very rare thing to find an aortic cusp 
actually ruptured by severe effort. It also 
occurs in gouty conditions with an.hyper- 
trophied left ventricle and a tense incom- 
pressible pulse; where the aortic valves are 
closed violently by the high blood pressure in 
the elastic arteries. The dust of fine-hewing 
irritates the lungs, as does flour in millers 
and bakers, fine dust in dry grinding, as 
needle grinding; and in other occupations 
where mechanical irritants are inhaled. Al- 
cohol worries the liver into cirrhosis. Too 
much nitrogenised material excites a growth 
of connective tissue in the kidneys — ' the 
gouty kidney.' In all these cases our know- 
ledge of ' the natural history of the disease ' 
should guide us as to prevention, and the 
avoidance of the provoking cause of mischief. 
In those chronic modifications of nutrition 
in the joints found in the strumous, rest is 
all important. The thick epiphyses of struma 
are easily provoked by slight external causes 
to take on changes of nutrition and growth. 
Instead of a moderate production of healthy 
cells, imperfect cells are produced in ab- 
normal quantities; there is an increase of 



ANAEMIA. 47 

quantity with a decrease of quality: until 
this may reach the production of pus or 
suppuration. To rest the part is as important 
as to improve the nutrition; while 'diseased 
tissues need the baptism of healthy blood for 
regeneration,' they also equally need rest for 
repair. If a knee, it should be put at rest 
with a leather case well fitted on, so as to 
abolish movement. If the hip joint is the 
seat of disease, take off the weight of the 
body by an appropriate splint; or if the 
patient is in bed, keep the head of the femur 
and the cup of the pelvis apart if possible, as 
pressure will lead to ulceration. If the spine 
is weak, take off the weight of the head and 
shoulders from the spine, by an external 
skeleton resting on the iliac crests and sup- 
porting the head and shoulders. Relieved 
from the superincumbent weight, repair is 
favoured in the spinal column ; which, when 
handicapped by that burden, must have got 
worse. What the surgical measures, Sayre's 
jacket, or what should be, it is scarcely my 
province to. say; I merely point out here 
the principle which must guide your practice 
— show how your practice can be rational. 
Under favouring circumstances the natural 
efforts at repair are often very successful. 

CHAPTER V. 

ANEMIA. 

It is usually easy enough to see that a patient 
is anaemic; but it is not so easy always to 
determine on what that anaemia depends. It 
may be due to want of food, or to imperfect 
assimilation. It may arise from a drain, as 
diarrhoea or lucorrhoea ; or it may arise from 
gonorrhoea, when it is due to chagrin and 



48 ANAEMIA. 



discomfort telling on the digestive organs, 
rather than the mere loss by the discharge. 
Or constipation may occasion it. In woman, 
especially, a drain is no uncommon cause of 
anaemia. In such case it is well to prescribe : 

Mag. Sulph., 3 ss. 
Tinct. Fer. Mur., 1JB x. 
Tinct. Capsici, tijj iv. 
Inf. Quassise, I i. 
Ter in die. 

In elderly persons, and in women at the 
change of life, warm carminatives in their 
mixtures are always indicated; and they are 
always comfortable to any one taking a 
purgative. I believe this has been said be- 
fore, but it will stand repetition. When due 
to, or associated with a drain, stop the drain 
by appropriate measures. 

In simple ancemia, as seen in girls at puber- 
ty, any form of iron is useful. If very anae- 
mic, send them to bed for a week or two. 
Especially is this necessary when the patient 
is an overworked servant-girl. I well remem- 
ber a girl at the West London Hospital who 
was under my care for fourteen months, and 
in spite of every combination of iron and 
tonics, she stood still. She was sent into the 
hospital and put to bed, and under an ordin- 
ary steel mixture, in a week, most distinct 
and perceptible improvement was made ; and 
in a week or two more she was all right. I 
have not forgotten that lesson; and I hope the 
reader will not. 

In childhood it is well to give lime as well 
as iron ; and Parrish's chemical food is a very 
pleasant form of this combination. Often in 
strumous children cod-liver oil works won- 
ders. Then there are special circumstances 
which affect the anaemia, and require special 
and appropriate measures. In the anaemia so 



ANEMIA. 49 



often found with consolidation of the apices 
of the lungs, it is useless to give iron, as an 
haematic, if at the same time the night sweats 
are allowed to go on unchecked. 

In malarial poisoning and the subsequent 
anaemia often seen, it is useless to give iron, 
unless at the same time the specific — quinine 
— be given with it. If there be congestion of 
the liver, with tenderness over it and a foul 
tongue, it is utterly useless to give iron. 
Clear out the liver and get the tongue clean, 
and then chalybeates will do well: 

Quin. Sulph. gr. ij. 
Tinct. Fer. Mur., 
Ac. Phosph. Dil., aa TIDx. 
Aq.. ii 

Ter in die; 

but if this be not done, it is waste of time to 
give iron. 

If there is toxic anaemia, as in lead-poisou- 
ing, it is desirable to get the lead out of the 
system by the iodide of potassium, as well as 
to order steel. In mercurial, or copper pois- 
oning, it is necessary to prevent more of the 
poison entering the system; and to let what is 
in get out, as well as give chalybeates. 

In gouty patients suffering from anaemia, 

while there are active symptoms, iron is of no 

service, unless it be given along with potash : 

Pot. Bicarb., gr. x. 
Ferri. Aram; Cit., gr. v. 
Inf. Quassise, ?i. 
Ter in die; 

well diluted with water, is a capital combina- 
tion. Usually it is well to let the active 
symptoms subside before resorting to iron. 
It would indeed be well to commence with 

Sod. Sulphat , 
Sod. Pot. Tai*t., aa 3i. 
Tinct. Nuc. Vom., rrg x. 
Inf. Gentian, 3 i. 
Ter in die, 



5€ ANEMIA. 

until the tongue is clean and all active symp- 
toms are removed; then follow with the 
potash and iron. After rheumatic fever this 
combination is indicated for a while. 

In aiKBinia of syphilitic origin, a very wide 
class, I am sorry to say, it is necessary to give 
mercury freely. I hold with H. C. "Wood in 
favor of mercury versus large doses of iodide 
of potassium. At present the iodide is given 
in very large doses, £ss. to gi. Sometimes in 
syphilitic ulceration the iodide is to be pre- 
ferred to the mercurial alone. But it is well 
to combine the two : 

Liq. Hyd. Bichlor., 3 ss. 
Potas. Iodidi, gr. v. 
Inf. Gen.. 3 i. 
Ter in die, 

is a useful form. But in the ordinary cases 
of anaemia, which is sometimes very acutely 
induced at an early period, it is well to pre- 
scribe the following combination : 

Liq. Hyd. Bichlor.. 3 ss. 
Tinct. Fer. Mur.. ttjjx. 
Inf. Quassiae, 3 i. 
Ter in die. 

By giving iron with the mercury, full doses 
of the latter may be given to broken-down 
subjects without fear. My own individual 
experience has been that while I use mercury 
very freely in syphilis, no case of salivation 
or other mercurial trouble has occurred since 
iron has been systematically given with the 
mercury. *In the anaemia of syphilis, whether 
it be acquired or inherited it matters not, al- 
ways stick to the last combination; whatever 
local measures may be indicated. When the 
treatment has to be continued some time, it 
is well to give the two in pill form, which is 
tasteless and does not spoil the teeth. 



51 



Hyd. Bichlor., gr. v. 
Fer. Sulph. Exsic, 31. 
Pulv. Pip. Nig., 3ij. 
" Pil. Al. et Myrrh., q. s. ft. 
Inpil. 60div. 
1. bis in die. 

Then it may be well to rub in a piece of blue 

ointment, the size of a large pea. every night, 

either into the inside of the limbs, or over the 

rash ; if rash there be. Also feed up the 

patient. 

Continue the treatment so long as any evi- 
dence of syphilis remains; and a little longer. 
Hound the poison out of the system thorough- 
ly and effectively; and perhaps the patient 
will never know more of it. When after the 
lapse of years a patient manifests syphilis in 
its later form, ' go for ! the poison again ener- 
getically. Syphilis, like gout and malaria, 
often shows itself actively after lengthened 
periods of quiescence; and like them requires 
active treatment at those times. In inherited 
syphilis, it is well to give Hyd. c. Greta, in two 
or three grain doses every night, when there is 
a copper-hued bottom, or the distinctive spots 
or 'snuffles.' This clears out acid masses of 
mucus in the alimentary canal. If there are 
sores, they should be washed, and then dust- 
ed with calomel. The treatment should be 
continued a month after apparent complete 
restoration to health. Relapses occur in chil- 
dren as in adults, and must be actively treat- 
ed. As a chalybeate to meet the general con- 
dition of anaemia or malnutrition in the qui- 
escent intervals, the syrup of the iodide from 
Til xx to tti xl three times a day is indicated. 

Then there is a form ot anaemia and mal- 
nutrition in infants and children from exces- 
sive appetite, or 'bulimia.' It is commonly 
seen after whooping-cough and measles. Here 
there is chronic inflammation of the mucous 



52 PLETHORA. 

membrane of the aliment arj' canal, and. sensa- 
tions of hunger are intensified. The. child eats 
incessantly; and the more it eats the more it 
wastes. It digests very little of the large 
amount it eats; it grows hungrier and hun- 
grier, of course; and if the mother cannot, or 
will not restrain it to light meals of easily 
digested food, with proper intervals of rest 
for the stomach, the child will die. It may 
be well to prescribe : 

Pot. Brom., gr. ij. 
Aq. Anethi, 3 i. 
Ter iu die, 

to soothe the mucous membrane and diminish 
the sensations of hunger. 

PLETHORA. 

Is the opposite condition to anaemia — 
where there is too much blood in the sys- 
tem. Here it is well for the student to deter- 
mine whether there is 'true plethora,' with 
a full artery as well as a full vein ; or venous 
congestion with a slack artery. If the latter, 

Tinct. Digitalis, Tip x. 
Inf. Cinchonas, ? i. 
Ter in die, 

may be given as well as the Pil. Cal. Col. Co. 
at bedtime twice a week, and the saline 
draught in the morning. In the true plethora, 
with a tight pulse and often a throbbing head, 
it may be well to give 

Elaterii, gr. 1-16. 
Pulv. Jalap Co., 3 ss. 

at once, and follow with the mixture of nux 

vomica, three times a day. In cases of 

amenorrhcea in florid women, with plethora, 

it is well to use this mixture freely, and to 

order hip-baths when the menstrual period 

ought to be present, and the patient feels as 

if it were coming on. A regulated dietary 



BLOOD POISONS. 53 



poor in albuminoids is necessary where a ten- 
dency to plethora of fulness of blood exists, 
no matter at what period of life or in which 

sex. 

■ » 

CHAPTER VI. 

BLOOD POISONS. 

The student will often be brought face to 

face with conditions of blood-poisoning. This 

may be acute, from some poison absorbed 

from without the body; or more chronic 

from pus absorption within the body; or 

other matter, as in pyaemia. The treatment 

of blood poisoning is not very satisfactory. If 

it takes the form of diphtheria, with the 

throat patches; the line to adopt is to support 

the system by beef-tea and milk, giving wine 

when matters are critical, and the following 

combination : 

Pot. Chlorat. gr. iij. 
Tinct. Fer. Mur., ttqjv. 
Syr. Aurant, 3 ss. 
Aq. ad.j 3 ii. 
6ta quaque hora, 

for a child of seven or eight; for an adult 
twice this dose, at four hours' interval. If 
there are accumulations of pus in the inter- 
muscular planes let it out freely; and it is 
well to do this antiseptically. For the treat- 
ment of blood poisoning we resort to 

ANTISEPTICS. 

These are agents which unite with organic 
matter in a state of molecular change, and in 
uniting therewith make insoluble and there- 
fore inert compounds. Just as in lead- 
poisoning sulphuric acid well diluted is given, 
to form the inert sulphate of lead, so in blood 
poisoning the sulphites are given to unite with 
and render inert the acting poison. 



54 BLOOD POISONS. 

Sod. Sulphit., 3i. 
Pot. Chlorat.. gr. ii. 
Aq. Menth. Pip. I i. 
4ta quaque hora, 

is good. Carbolic acid in atomized spray is 
often useful "for the patient to inhale. Or 
salicylic acid may be tried, as a salicylate 
of soda, 3ss. to gi. quater in die. Some of 
these agent, as Condy's fluid and chlorate of 
potash, both rich in oxygen, are supposed to 
act by furthering the oxidising processes, and 
so rendering the poison inert. Condy's fluid 
should be sprinkled about the bedroom ; while 
a sheet kept moist with a solution of it, or 
chloride of lime, should be hung over the 
door of the room. As a prophylactic to be 
taken by the attendants, the following is 
good, and not unpalatable. Take an oz. of 
chlorate of potash, put it in a quart bottle of 
wine with the juice of two good-sized lemons ; 
shake the whole till dissolved; then take a 
wineglassful three times a day. This is very 
good when there is scarlatina in the house; 
or for those in attendance upon patients suf- 
fering from acute blood-poisoning. 

The treatment of the more persisting 
pysemiae cannot be discussed here; but the 
line is to give the sulphite mixture regularly, 
and to keep up the patient's strength by good, 
digestible food, wine, and other stimulants; 
and thus enable him. if possible, to weather 
the storm. 

Malarial-poisoning takes the form of fever 
and ague, or dysentery. Iuiever and ague 
recurring in a person who has beeu subject to 
it, it is well to give 

Quin. Sulph., gr. iv. 
Tinct. Digital., m s. 
Ac. Phosph. Dil., ttq xt. 



A 3r 2. 1 
Ter 11 



in die. 



MALARIA. 



55 



with a Pil. Cal. Col. Co., at night, and mer- 
curial tonic in the morning. The poison lying 
chiefly in the portal circulation, evacuants 
are indicated ; as well as the malarial specific, 
quinine. 

In malarial dysentery, not the putrescent 
dysentery of camps, it is well to give ipeca- 
cuan in full doses. Say you give tti xv of 
laudanum to a patient, and in two hours, 
when the stomach is under the influence of 
the narcotic, 

Pulv. Ipecacuan., 3 ss. 

The patient for a few hours will be deadly 
sick, then vomit, and next day there is a nor- 
mal stool containing bile, and the dysentery 
is relieved. If not thoroughly successful in 
the first attack, repeat the manoeuvre. 

In the general management of specific 
fevers there are points to be attended to in 
all cases ; special points in particular maladies. 
Firstly, remember that the infectious power is 
at the decline of the malady; in scarlatina so 
long as there is an effete epidermal scale to be 
shed ; in small-pox so -long as there is a scab 
to fall. In measles we do not exactly know 
the peculiar infecting agent — possibly a 
mucous epithelial scale; but this is pure 
hypothesis. In typhoid fever the stools 
should be passed into a utensil containing a 
disinfectant, as chloride of lime or carbolized 
powder : some more of the disinfectant should 
be thrown over the motion as quickly as pos- 
sible, which should then be buried some dis- 
tance from the house, or in towns otherwise 
disposed of. These measures should be 
adopted for the protection of others. Now 
for the patient. 

We will suppose the case to be scarlatina. 



56 SCARLET FEVER. 

Having made his diagnosis, he will put the 
patient into a good airy bedroom, and allow 
plenty of fresh air. With the rising temper- 
ature and the burning skin there is little fear 
of catching cold. But when the fever has 
defervesced, the skin is cool, and the epider- 
mis is peeling, chills are readily caught with 
the thin sensitive skin; then be very careful 
about cold. If the case is one of ordinary 
severity, give 

Pot. Chlorat., gr. x. 
Syr. Aurant., 3 i. 
Aq. an. 3 ss. 
tita quaque hora. 

If the throat is ulcerating, add Tinct. Fer. ■ 
Mur., ttix., to each dose, and give wine and 
beef-tea. Otherwise milk, milk and lime- 
water, or seltzer-water, should be the staple 
food. Cold sponging with vinegar and water 
may be practiced so long as there is distinct 
fever. When the fever is over, rub the pa- 
tient over daily with carbolized oil, one part of 
carbolic acid to forty of linseed oil, or cocoa 
butter. The patient should be washed daily, 
and then rubbed over with this carbolized oil. 
By this means the falling scales are disin- 
fected and removed. Be very careful against 
cold for a month after the appearance of the 
rash : very careful indeed. If the urine be- 
come albuminous, put the patient in flannels; 
sweat him, or her, in a warm bath; then 
purge with 

Elaterii, gr. A. 

Pulv. Scam. Co., gr. iij., 

for a seven year old child; and don't be 
afraid that this will kill a strong child. Give 
milk and potash water, and 

Pot. Bicarb., 
Fer. Aram. Cit., aa gr. v. 
Aq., §ss. 
Ter in die. 



SMALLPOX. 57 



Any chalybeate tonic may be adopted in the 
convalescence. 

In measles, remember the lung complica- 
tions, and be on your guard against cold; in 
this, the early treatment differs from that of 
scarlatina. Put the children in a large room, 
and take care of draughts. If the mother has 
given some saffron tea "To strike out the rash," 
don't snub her or condemn it ; to do so would 
only be to let yourself down in her opinion, 
instead of convincing her: it.is a time-hon- 
ored remedy. Then give each child 

Vini Ipecacuan., HP v. 
Syr. Zingiber., vel 
Syr. Tolutan., 3 ss. 
Liq. Amm. Acet., 3 i. 
4ta quaque hora, 

dieting as in scarlatina. With care the chil- 
dren should get through all right. If the lung 
symptoms are threatening, an emetic of sul- 
phate of zinc Oss. in § ii. of warm water) is 
indicated; and a grain of carbonate of am- 
monia to each dose of the above mixture. 
When convalescing, it might be well to give 

Sal. Volatile, grs. x. 
Inf. Cinchon. Flavae, 3 ii. 
Ter in die. 

When called to a case of smallpox, get the 
patient away if possible. If this cannot be 
done, give something like this : 

Ac. Phosph. Dil., M xv. 
Syr. Zingib. 3 i. 
Aq ad, \ i. 
4ta quaque bora. 

Darken the room to check the development 
of vesicles on the face, and feed the patient. 
Patients will become severely ill with small- 
pox, and yet often recover. If prostration is 
setting in, I should feel inclined to try 

Am. Carb., gr. iv. 
Pot. Chlorat., ass. 
Inf. Cinchon., $i. 
4ta quaque hora. 



58 WHOOPING COUGH. 

The patient must be encouraged not to scratch 
the face, or pick the irritating scabs from the 
nose, else severe pitting will follow. A mix- 
ture of olive oil and calamine, in pro- 
portions enough to make a thin paste, is re- 
commended to be painted over the face daily, 
to reduce the risk of pitting. 
In whooping-cough it is well to give atropine. 

Liq. Atrop. Sulph., tijj i. 
Aq. Anethi., 3 i. 
6ta quaque hora. 
• 
If the respiration be excited, 

Pot. Brom., gr. v. 
Syr. Tolut., 3 ss. 
Aq. 3 iss. 
4ta quaque hora. 

may give better results. But study the char- 
acter of the respirations ; if shallow and 
rapid, atropine is indicated. Children stand 
belladonna well. If the child vomits with its 
cough, then feed it milk, or milk-gruel, 
immediately after it vomits ; so that the food 
may be digested and get out of the stomach 
before the next paroxysm. After the true 
whooping-cough is gone, a troublesome cough 
of like character may remain, a resultant 
' trick ' of .the respiratory centres. Here it is 
well to prescribe : 

Quin. Sulph., gr. i. 
Ac. Hydrobrom., tTTJ xv. 
Aq., 3 ii. 
Ter in die. 

which often is very successful. After that 

any chalybeate, as 

Vin. Fer. 

01. Morrh., aa 3 i. 
Ter in die, 

or half a drachm of Parrish's food thrice daily. 

Influenza is a depressant form of catarrh; 

more depressant than is generally credited. 

For it, give 



ERYSIPELAS. 59 



Am. Carb., gr. iv. 
Sp. Chloroform., 11)3 xx. 
Inf. Cinchon., li. 
Ter in in die. 

and, if necessary, a pill at bedtime. 

A good pill in catarrh, chronic bronchitis, 
etc., for nights of broken rest from cough, is 

Pulv. Ipecacuan., gr. ss. 
Pulv. Opii.,gr. i. 
Pil. Scillse. Co., gr. ii. 
o. n. 

Where there is much embarrassment of the 

respiration, then 

Liq. Morph. Mur.. nj xxx. 
Liq. Atropiae Sulph., Hfl iii. 
Aq. Menth. Pip., § ss, 
o.n., 

is to be preferred. Any dimness of vision, 
or dryness of the throat from the belladonna, 
is quite unimportant; any action on the pupil 
no reasoning person would heed; for of what 
significance is it? It is one of the medical 
'bogeys,' that's all. If the patient is incom- 
moded by the dimness of vision, as a needle- 
woman or an engraver, then it must be with- 
drawn ; or if the throat be disagreeably dry, 
the belladonna may be discontinued. 

Erysipelas appears in two forms, as a spread- 
ing dermatitis resulting from an injury, and 
as a specific disease in the face and head. As 
a mere dermatitis 

Plumbi Acetat., bss. 
Tinct. Opii., ?ss. 
Aq., I xx. 

is good, applied on lint covered with oilskin ; 
and to regulate the bowels, if the tongue be 
furred, by the means often spoken of in 
Chapter V. , and to treat the patient accord- 
ing to the general condition, and the tempera- 
ture according to the rales laid down in 
Chapters III. and IV. In true infectious 
erysipelas, it is well to give 



60 GROWTH AND DECAY. 



Quin. Sulph.. gr. i. 
Tinct. Fer. Mur., IIJJ v. 
Aq. II. 
6ta quaque hora, 

to use the lead and opium lotion warm, or to 
dredge the face well with flour ; this last is 
very desirable when there is much exudation, 
as this fluid possesses a high infecting power. 

[A solution of hyposulphite of soda and 
tr. iodine and glycerin are useful local appli- 
cations for erysipelas.] 

In the treatment of the pyrexia associated 
with blood-poisoning proper, not specific 
poisons, it is well to adopt the measure advo- 
cated for ' ' wet-skinned " fevers, spoken of in 
Chapter III. 



CHAPTER VII. 

GROWTH AND DECAY. 

It is well for the student to remember that 
the anatomical basis of our divisions of mala- 
dies is a convenient 'arrangement for text- 
books, but is not so we'll adapted for the bed- 
side. Physiology must guide our practice 
ver} r much more than it has done, or was able 
to do in past times. A fair knowledge of 
anatomy has long been obtained, but such an 
acquaintance with physiology as is of any 
value in practice as a light and a guide, is as 
yet only possessed by comparatively few. 
Yet it must be the basis of treatment, just as 
anatomy is the basis of diagnosis. 

An infant is often disturbed in its digestion, 

has a swollen belly, with loose stools and 

much colic, evidenced by long cries. Here it 

may be well to see the mother, or nurse. If 

I she have leucorrhcea and cold feet, with con- 



TEETHING. 61 



stipation, put her right, and then the child 
will improve. Give her 

Sod. Sulphat., 31*. 
Pot. Bicarb , grs. x. 
Tinct. Zingib., I1J} xx. 
Inf. Cascarillae, 5 i. 
Ter in die. 

and instruct her about using injections for 
her leucorrhcea. If the child be weaned, see 
to its having the milk of one cow, or the 
Swiss preserved milk — a great advantage to 
town children. If the child is still griped, 
or if it still throw up its milk firmly curdled, 
give it 

Potash. Bicarb., grs. ii. 
01. Cajeput., TT|3 i. 
Syr. Zingib.. ttq xv. 
Aq. Anethi, 3 i. 
6ta quaque hora. 

If hand-fed, a little prepared chalk or mag- 
nesia powder in its milk is indicated. 

[Cows to afford wholesome milk for infants 
should be healthy, and have good food 
and care. Overheating by driving, and un- 
wholesome food and drink — distillery feed — 
will induce unwholesome milk.] 

Teething often gives trouble, and then it is 
well to see to the gums, and lance them when 
a tooth is protruding, and the point is hot 
and tense. Gut the point, or points only; don't 
draw a lancet along the whole gum, and so leave 
a cicatrix to divert the teeth, that are yet to 
come, from the straight line. When there is 
much irritation produced by the teething, you 
may prescribe 

Pot. Brom., grs. v. 
Aq. Anethi, 3 i. 
Quater in die. 

If there be any heat of. head and constipa- 
tion, add Tinct. Sennse, ttj, xx., till the bowels 
are well opened. 



62 



HYDROCEPHALUS. 



When there is hydrocephalus suspected, or 

present, give this 

Pot. Brom. grs. iij. 
Pot. Iod . grs. j. 
Aq. Anethi, 3 i. 
6ta quaque hora. 

The plan of blistering the head with croton 
oil liniment has still its advocates; but it is 
not now. fashionable. 

Then there is infantile remittent fever, with 
its diurnal variations of temperature, com- 
mon in children. Open the bowels with 

Pulv. Scam. Co., grs.. vi., 
for a seven-year-old child, first thing. Then 
give it. 

Quin. Sulph. , gr. h. 
Ac. Phosp. Dil., TTE v. 
Aq. Anethi, 3 ii. 
Ter in die. 

Remember that of all the acute maladies of 
children, indigestion stands fii'st in the rapid- 
ity with which the symptoms develop ; and 
the temperature rises. Give an emetic, 

Cal., grs. iv. 

Pulv. Ipecacuan, grs. x., 

and get the offending mass off the stomach at 
once. After this the temperature usually 
falls, especially when the calomel acts on the 
bowels. If a delicate child, it may be well 
to give the ipecacuanha without the calomel, 
and after the child has been sick, to give it a 
dose of castor-oil, say % ss. When there are 
frequent attacks of indigestion, give strict 
injunctions regarding its dietary — milk, sim- 
ple milk puddings, or a little soup or fish ; 
little meat or pastry ; but stewed fruit and 
cream ad libitum. Then give it " 

Sod. Bicarb., grs. iii. 
Bism. Trisnit.. grs. v. 
Mist. Acacise, x, 
Inf. Calumb., 3 ii. 
Ter in die, 

before its meals. 



CHOREA. 63 



Very often you will get a distinctly strumous 
child to deal with. Diet it as above, and give 
after food 

Vin. Fer. 
01. Morrh., aa 31. 
Ter in die, 

and you will usually be gratified by seeing 

that the child improves very decidedly. Send 

it to the sea-side, and when the stomach has 

been put right by the bismuth mixture, give 

it the oil and steel wine, and plenty of butter 

on its bread. 

Then be watchful as to the subject of 

growth. Children grow by fits and starts. 

When acutely growing they are not idle but 

languid ; and cannot ' do their lessons.' Put 

them to bed and give them 

Quin. Sulph., gr. ss. 
Ac. Phosph. Dil., Tty v. 
Aq. 3 ii- 
Ter in die, 

and let them have plenty of milk. In conse- 
quence of the growth of the epiphyses, pain 
in the joints is often experienced and attri- 
buted to rheumatism. 

If rheumatic, a mixture of potassium bicar- 
bonate and the ammonium citrate of iron is 
indicated. 

Chorea is common in children. When it is 
the result of fright it is apt to be very in- 
tractable. When the result of seat -worms 
give 

Pulv. Scam. Co., grs. iv., 
to be repeated till the worms are all expelled. 
Then give 

Pot. Brora., grs. v. 
, Fer. Pot. Tart., grs. iv. 
Aq. 3 ii. 
Ter in die. 

At other times, when the chorea is evidently 
due to a 'growing fit,' where the spinal cord 



64 INCONTINENCE OF URINE. 

is tardy or lingering in its consequential 

growth, 

Liq. Arsenic. Hydrochlor., iii. 
Tinct. Fer. Mur., Tip v. 
Aq. Menth. Pip., 3 ii. 
Ter in die, 

will often do good service. If the child is 
very ill keep it in bed. 

When a child is badly nourislied, and you 
have put its bowels in order, given it steel 
wine and cod-liver oil, and yet it does not 
thrive, it may be well to rub it daily with 
olive oil or neat's foot oil — cod-liver oil smells 
too unpleasantly. Let the mother first wash 
it with so ip and water to clean away the 
epidermal cells and oil of the previous in- 
unction and 'cleanse the pores of the skin,' 
and then rub the infant's body well before the 
fire, with half an ounce of oil. This will 
often produce results at once surprising and 
satisfactory. 

Incontinence of urine in children is a com- 
mon malady. It arises usually from hyper- 
esthesia of the vesical centres in the lumbar 
portion of the cord, so that in sleep any irri- 
tation in the pelvis, as ascarides in the rectum, 
is apt to cause these centres to relax the vesi- 
cal sphincter — misinterpreting the irritation 
for the call of a full bladder. First remove 
any local irritation, seat-worms, a long pre- 
puce, etc., and then give' 

Liq. Atropiae Sulph., W. ii. 
Aq. Anethi, 3 i. 
Ter in die. 

[The Liq. Atropiae of the British Pharma- 
copoeia is of the strength of four grains of Atro- 
piae Sulph. to 3 j Rect. Sp. and 3 vij of water.] 

Children, like rabbits, stand belladonna well; 
do not be afraid of poisoning them with any 
reasonable dose of atropia. Also bear in 



OLD AGE. 



65 



mind that the irritability of the bladder so 

common in old men, where their rest is 

broken by having to get up several times to 

make water, is greatly relieved by belladonna. 

Liq. Atrop. Sulph., Tin i. 
Inf. Buchu, vel 
Mist. Camph., 3i, 
Ter in die, 

will often give decided relief, 

In the treatment of children avoid two ex- 
tremes in the use of calomel ; do not look 
upon it as a panacea always to be given, nor 
go to the other extreme of never giving it. 
In troubles in which the liver is involved, an 
occasional dose of calomel is excellent at any 
period of life, save for persons with cirrhosed 
or contracted kidneys — in other words, the 
subjects of Bright's disease, who are very 
susceptible to mercury, as they also are to 
opium. With these persons both these agents 
are simply 'poisons.' 

OLD AGE. 

When approaching old age is beginning to lay 
his grip upon the organism, and the changes 
known as ' senile ' are inaugurated, our prac- 
tice must be modified. As age progresses, the 
utility and tolerance of iron diminishes. 

In conditions of debility in young persons a 

chalybeate tonic is almost universally indi. 

cated, but with elderly persons something of 

this kind is to be preferred as a pleasant 

tonic: 

Amm. Carb., grs. iv. 
Sp. Chloroformi, njj xx. 
Tinct. Nuc. Vom., ttjj x. 
Inf. Cascarillae, 3 i. 
Ter in die, 



Sal Volatile, 33. 
Sp. Chloroformi, H\) xx. 
Inf. Cinchon. Flavae, 5i. 
Ter in die, 



All laxatives must be well charged with 
carminatives Such a pill as : 

Strychniae, gr. ^ 
Pulv. Pip. Nig., gr. ss. 
Pil. Col. Co., grs. iiss. 

every second or third night, is indicated in 

constipation. For the morning laxative the 

following are useful : 

Haust. Nig., §i., 

in an ounce of hot water, or Hunyadi Janos 
a sufficiency, with a teaspoonful of tincture 
ginger, and some hot water. Ordinary pur- 
gatives, as effervescing salines, are apt to lie 
too cold on the stomach for elderly persons. 

If their assimilative organs become impair- 
ed, the dietary of childhood is desirable. 
Mentally and bodily, we find the proverb 
' once a man and twice a child ' holds good. 
Milk puddings, stewed fruit and milk, or 
cream, bread, butter, and jam, or honey; fish, 
poultry, game ; little kickshaws rather than 
solid meat, should form the bulk of the die- 
tary. Remember that whether bile acids or 
lithates, the troubles of advanced life are in- 
timately linked with the presence of nitroge- 
nized waste in the blood. 

Elderly persons soon lose heat, and should be 
well clad, especially whenever the weather is 
cold. This is very true of those who suffer 
from bronchitis or emphysema. In cold 
weather keep them warm. Give them ' treacle 
posset ' to go to bed with, if up. A warmed 
bed, a draught of hot fluid with alcohol, are 
required for ' the chill blood of age. Where 
they are teetotallers, 'treacle posset,' or a 
cupful of hot beef-tea, may be given instead 
of the alcoholized draught. When either 
extreme of life is attacked by bronchitis, 
keep up the system — feed. 



RHEUMATISM, GOUT, AND DIABETES. 67 

As a cough mixture for old persons with 
chronic bronchitis the following is indicated : 

Am. Carb., grs. v. 
Sp. Chloroformi, III) xx. 
Tinct. Nuc. Vom.Hp vi. 
Inf. Senegae, ?i. 
6ta quaque hora, 

to which may be added ten drops of tincture 
of digitalis if the pulse falters, indicating 
embarrassment of the right side of the heart. 



CHAPTER VIII. 

RHEUMATISM, GOUT, AND DIABETES. 

In acute rheumatism put the patients to bed 
in a flannel shirt, and in blankets ; nothing 
but woollen clothes near them. Enjoin abso- 
lute rest for the sake of the cardiac valves 
for several days after all active symptoms have 
disappeared. Use a hot bran bag or a poul- 
tice for pain within the pericardium, and hot 
solutions of bicarbonate of soda, ( § i to 
§ ii, with laudanum half an ounce) on flan- 
nel wrapped round the swollen painful joints. 
Internally : 

Pot. Bicarb., 3 j. 
Tinct. Opii. , TTfl tv. 
Inf. Serpentariae, vel 
Inf. Buchu, I i. 
6ta quaque hora, 

with a copious draught of water is good; the 
opium being increased or decreased accord- 
ing to the pain — mind this. Others prefer : 

Sodae Salicylat., 3i. 
Mist. Camph. ?i ; 

but the first always served me well. At night : 

Pulv. Opii., grs. ii. 
Pulv. Aloe Co., grs. iii. ; 



Pulv. Opii., grs. ii. 
Plummer's Pil., grs. ii. 



RHEUMATISM, GOUT, AND DIABETES. 



may be given with advantage. Do not dis- 
turb the patient too much by giving purga- 
tives ; but if necessary, give a purgative 
water, a dose of Carlsbad salts, or a Seidlitz 
powder. When the active symptoms subside : 

Pot. Bicarb., grs. x. 
Fer. Am. Cit., grs. v. 
Inf. Quassiae, § i. 
Ter in die, 

well diluted with water, slides the treatment 

from alkaline to chalybeate very agreeably. 

If a strumous young person, give cod-liver 

oil as soon as possible ; and get the patient to 

the seaside as soon as the weather and the 

condition will permit. 

[n chronic rheumatism it is well to pre- 

' scribe : 

Pot. Iod., grs. iii. 
Pot. Bicarb., 3 ss. 

Inf. Serpentariee, ?el • 

Inf. Sarsse., %i. 
Ter in die, 

with Pil. Cal. Col. Co., grs. v., once or twice a 
week at bedtime. Then order a liniment, 
either Lin. Terebinth, or Lin. Camphoric, to 
be rubbed well over the painful part night 
and morning. When there is sciatica, give 
the above, and for a local application : 

Lin. Aconit. , 3 ii- 
Pulv. Opii. 3i. 
Sacch. Fcecis., 3 ii. 

spread on a V-shaped piece of lint, laid over 
the course of the nerve, with the point 
downwards ; covered with a similar piece 
of oil silk about half an inch larger, and secur- 
ed by a long stocking, with the foot cut off, 
drawn over all. Don't change the piece of 
. lint each day when the new dose of analgesic 
has to be applied. 

Gout is a troublesome malady to treat. First 
let us take an acute attack with very painful 



GOUT. 



joints. The Cal. and Col. Pil. with the Sod. 

Sulph. and Pot. Tart, mixture may be given 

every second night and morning ; then, 

Pot. Bicarb., 3i. 
Sod. Bicarb., 3 ss. 
Tinct. Hyoscyami, y ss. 
Inf. Buchu, 3 i. 
Ter In die, 

well diluted with water. Colchicum, you 
observe, is not in this mixture. I never give 
colchicum to a private patient ; my belief is, 
it arrests the gouty inflammation, and 'bottles 
up ' the gout-poison in the joint. I have seen 
patients sodden with gout-poison from the 
continuous use of colchicum, improved very 
greatly in their next attack from letting the 
' gout ' run its course, and getting the sys- 
tem cleared of the poison. Attacks of gout 
clear the system, as thunderstorms cleiar the 
air in sultry weather. But as the gouty 
patient may be suffering keenly, and you and 
he may not be very thoroughly acquainted, it 
perhaps may be well to add. 

Vin. Colchici, M xv. 

to the mixture. To hospital patients, who 
must be well as soon as possible to work for 
wife and children, I never withhold colchi- 
cum ; but nevertheless, in reality it is ' bad 
practice!' The old and still favorite measure 
with many practitioners is : 

Mag. Sulph., 3 j. 
Mag. Bicarb., grs. v. 
Vin. Colchici., nji xv 
Aq. Menth. Pip., 1 i. 
Ter in die, 

and it is not a bad measure for giving relief 
in cases of acute articular gout; but, on the 
whole, the Pot. Bicarb, treatment is to be 
preferred. When the gout is firmly located 
in the patient, or in common parlance he is 
'eaten up with gout,' 



70 



HEADACHE. 



Pot. Iod., grs. iii. 
Pot. Bicarb, 3 ss. 
Inf. Gentian., 3 i. 
Ter indie, 

swallowed with copious draughts of water, is 
a good measure. Then the food should con- 
sist of fruit, farinaceous foods, fish and fat — 
the four F's; albuminoid foods being taken 
but sparingly. 

Diabetes is a disease not to be confounded 
with mere glycosuria, as it has been too fre- 
quently. When the result of shock or emo- 
tion of whatever kind, it is far from intracta- 
ble to treatment. Opium in doses of from 
one to two grains night and morning, or 
codeia gr. \ ad gr. i, are often of much ser- 
vice. Then the patient may have a chaly- 
beate tonic, with advantage. A great matter 
is the avoidance of starch and sugar ; and a 
diet of meat and vegetables, known as greens, 
or of almonds or gluten biscuits is indicated. 
But for small quantities of sugar, especially 
in stout persons, and where there is no ill- 
health complained of, do not be too heroic in 
your dietary; just avoid sugar. Many a dia- 
betic has been made much worse by a too re- 
stricted dietary; but do not tell an examiner 
so, as your statement might be attributed to 
ignorance. 



CHAPTER IX. 

SLEEPLESSNESS — HEADACHE— COUGH— PALPI- 
TATION, ETC. 

Beyond the conditions requiring general 
management of the patient, there are some 
more special matters to be considered. They 
may well be taken from above downwards. 

Headache is a common complaint. If it is 
periosteal, iodide of potassium in five grain 



DELIRIUM. 



doses is good. Where it is inflammatory in 

character, 

Chloral Hydrat. 
Pot. Brom., aa. 3 ss. 
Mist. Camph., %i. 
6taquaque hora, 

is a good combination. Clear out the bowels 
with a Cal. Col. pill at night, and the black 
draught, or its equivalent, in the morning. 
If there is a feeble pulse, with pam and 
weight at the vertex— the indication of cere- 
bral anaemia — Easton's syrup, or:- 

Cit. Fer. et Quin., gr. v. 
Liq. Strychnise, v\ v. 
Inf. Quass., ? i. 
Ter in die, 

is good. The same is good in cases of neural" 

gic face-ache, common in women ; here it is 

well to see if there are any drains on the 

system, as leucorrhcea, or menorrhagia. In 

epilepsy, however anaemic the patient, iron 

does not do well ; it may improve the general 

condition, but it aggravates the fits. It is 

better to give : 

Pot. Brom., 31. 
Mist. Camph., |i. 
Ter in die. 

Keep the bowels open, and see that the fits 
are not induced by a surfeit. Especially is the 
bromide useful in epilepsy associated with the 
catamenia. 

Delirium, when acute and not preceded by 
chronic evidences of brain disease, should 
not cause alarm, and does not in itself require 
treatment. If the head be hot, a bladder of 
cold water or of ice, is indicated. 

Sleeplessness is a matter often calling for 
treatment, and chloral hydrate is now largely 
resorted toby many persons, as- the numerous 
deaths recorded in the newspapers testify. 
When the patient complains of sleeplessness, 



72 COUGH. 



find out, if possible, the cause. If due to pain, 

give opium; but if there also be a full pulse, 

give it with antimony or with chloral. 

Pulv, Opii, gr. i. 
Antim. Tart., gr. %. 

is good in sleeplessness due to pain, as in an 
abscess or whitlow, [n inflammatory con- 
ditions: 

Tinct. Opii, gtt xx. 

• Chloral Hydrat., bss. 

Mist. Camph., ?i. 

will often furnish relief. Children do not 

tolerate opium well, neither do persons with 

chronic renal mischief. Then for an adult: 

Chloral Hydrat., bss. 
Pot. Brom. 31. 
Mist. Camph., §i., 

will often give relief. A draught of alcohol 

at bedtime is often of great service, especially 

where worry is the cause of sleeplessness. 

And, mind, never forget to see to the feet. 

Cold feet have more to do with sleeplessness 

than any one thinks who has not studied the 

subject. Neglect of this fact often spoils an 

otherwise good line of treatment. Rub the 

feet well with a rough towel, put a bottle of 

hot water to them, and the patient sleeps. 

For sleep a condition of cerebral anaemia is 

essential, and cold feet keep the blood too 

much in the head. When there is heat in 

the head, give chloral in ^ss. doses, or: 

Tinct. Aconit., gtt iv. 
Pot. Brom., 31. 
Aq. Menthae., ?i., 

at bedtime. Persistent, severe headache is 
often syphilitic in origin, and requires specific 
treatment. 

Cough may be due to trouble in the bron- 
chial tubes. If in the first stage of bronchitis, 

give : 

Pot. Iod., gr. v. 
Vin. Ipecacuan., njj x. 
Liq. Am. Acetat., I i. 
6ta quaque hora., 



73 



and allow the patient to inhale steam from a 
sponge or flannel wrung out of hot water, if 
more elaborate arrangements are not attain- 
able. It is often good practice, to add to the 
water some turpentine, so as to add its fumes 
to the steam. .This will produce relaxation 
of the congested mucous membrane, inducing 
free secretion, after which it becomes neces- 
sary to give stimulating expectorants — that is, 
agents which act directly on the respiratory, 
centres. These are ammonia, strychnina, 
and atropia. They may be combined thus: 
Am. Carb., gr. iv. 
Voi 



Tinct. Nuc. Vom., ttjj v. 
Inf. Serpentariae, |i. 
6ta quaque hora. 



or: 



Elix. Doverinae, 3 i. 
Liq. Atrop Sulph., HJ)i. 
Aq. Menth., 5 i. 
6ta quaque hora. 

A common mixture is: 

Am. Carb. gr. v. 
Spr Chloroformi, ttjj xx. 
Inf. Senegae, 1 i. 
6ta quaque hora. 

Never shake a mixture containing senega, 
if you can help it. Why ? — just do it once, 
for the sake of the experiment. 

Again, cough may be due to the presence of 
a new growth in the lung structure, as a mass 
of tubercle. Here the offending matter can- 
not be removed, so the cough must be allayed 
by suitable doses of opium or morphia, which 
will add to the night sweats, if existing, or 
excite them probably when not present ; this 
may be prevented by combining with them 
belladonna, thus: 

Elix. Doverinae, 3 i. 
Liq. Atrop. Sulph.. njj i. 
Aq. Menth., |i. 

o.n., 

which is a most excellent night draught. 

Then cough may be a neurosis, as is often 

seen in children of both sexes, and in young 



HEART DISEASE. 



women, simulating the cough of phthisis, and 
often causing much needless alarm. Here a 
tonic, like Easton's syrup, or any of the iron 
tonics, will do good. Or it may be well to 
give 

Pot. Brom., 3 ss. 
Tinct. Fer. Mur., IIP x. 
Aq. Mentbse. 5 i. 
Ter in die. 

If this lock up the bowels, as it is very apt 
to do, give Elixir Frangulaxine before break- 
fast; or add it to each dose. To treat a 
cough properly, is often to get great credit ; 
but to do so you must, usually, be clear as to 
its cause, and treat it accordingly. 

It may be due to vascular congestion, as in 
mitral disease, when digitalis will do more 
good than any other cough mixture. 
Heart Disease. 

This brings us to the matter of the treat- 
ment of palpitation. Where palpitation is 
not brought on nor increased by effort, do 
not give digitalis, but bromide of potassium. 
But when the arteries are empty, the veins 
full, and effort brings on palpitation, give 
digitalis ; no matter what the condition of the 
heart, whether mitral disease be present or 
not. No doubt in mitral disease digitalis is 
of the greatest service. 

Tinct. Digital., 
Tinct. Fer. Mur., fty x. 
Inf. Quass., I i. 
Ter in die, 

is in general vogue in heart weakness. It 
should be given steadily for weeks. If the 
patient be very weak, let him rest in bed. 
Rest is a potent measure in heart-disease, as 
you will see often enough in hospitals, where 
no medicinal treatment but simply rest in bed, 
makes a wonderful difference in the patient. 
But some digitalis will make the improve- 
ment more rapid, and keep up the improve- 



HEART DISEASE. 



ment when the patient leaves the hospital. 
It is well to combine strychnine with the 
digitalis, thus: 

Fer. Am. Cit. grs. v. 

Tinct. Digitalis, nc x. 

Tinct. Nuc. Vom., 1TB iv. 

Inf. Quass., ?i. 
Ter in die. 

This will often give you the most satisfactory 

results. Where there is chronic dilatation of 

the heart, with or without mitral disease, it is 

well to give digitalis in pill form. 

Strychniae, grs. ii. 

Pulv. Digital. 

Fer. Sulph. Exsic, aa 3 ss. 

Pulv. Pip. Nig., 3 i. 

Pil. Al. et Myrrh, 3 ss, m. ft. 

In pil. 60 div. ; i. bis in die. 

The nauseous taste of digitalis is thus 
avoided, and the iron does not effect the 
teeth; finally, there are no medicine bottles 
required. Keep up the treatment for months, 
or years if necessary. But when you find the 
palpitation not produced by effort, and there 
is a tense artery, and evidences of a hyper- 
trophied left ventricle, with accentuation of 
the aortic second sound, give the patient 
alkalies, and put him on a non-nitrogenized 
diet. Here is 'the gouty Jieart,' whether 
actual disease of the aortic valves be present 
or not. Give 

Pot. Bicarb., 3i. 

Sod. Sulphat., 3 i. 

Inf. Cascarillae, ?i. 
Ter in die, 

with a calomel and colocynth pill once or 
twice a week. If there is a gouty state with 
a feeble heart, or the hypertrophied heart is 
failing, ten drops of tincture of nux vomica, 
of digitalis, or, maybe of both, prevents any 
depression the treatment might otherwise 
cause. In girls and young women, where 
there is violent action of the heart, with vio- 
lent paroxysms of palpitation at times, see to 



76 DYSPNCEA. 



the bowels and iutra-pelvic irritation and 
treat accordingly. For the heart, if there be 
no mitral disease, digitalis is undesirable. 

Sod. Sulphat, 3 ss. 
Pot. Brom.. 31. 
Aq. Menthae, 1 i. 
Ter in die, 

is indicated. And put on a belladonna 
plaster. When thgre is a haemic murmur in 
the pulmonary artery, with palpitation in 
girls, that is, a condition of anaemia, give then 
a chalybeate and keep them in bed for a 
week or two. 

If a patient with known heart-disease has 
an attack of dysptum, is sitting in a chair, or 
propped up in bed; indeed, cannot breathe in 
the recumbent posture: what are you to do 
here? Put a hot poultice to the chest; heat 
stimulates the heart. Then give 

Am. Carb. grs. v. 
Tinct, Nuc. Vom. 
Tin t. Digital., aa !fl) x. 
Aq. Menthae, 1 i. 
4ta quaque hora, 

until relie f is attained ; then reduce the fre- 
quency of the dose. Keep up the strength 
with beef-tea, milk, and alcohol. It might 
be well to take a few ounces of blood from 
the arm if the heart be felt beating violently, 
and the pulse weak and the face congested — 
showing that the right ventricle is overtaxed. 
At another time there is dropsy with heart- 
disease. First put the patient on the last 
mixture for a couple of days at least. Then 
he must be purged. 

Elaterii. gr MO. 
Pulv. Jalap. Co., 3 ss. 

in the morning early will usually bring away 
a number of watery stools. Do not think 
this too heroic treatment; the profuse cathar- 
sis gives great relief. Then give Sir James 



INDIGESTION. 



77 



Simpson's bath. That is, fill six or eight 
lemonade bottles with boiling hot water: 
cork them tightly. Then wring as many- 
worsted stockings out of hot water. Draw 
the wet stocking over each bottle, and pack 
them one by one round the patient in bed. 
In from thirty to forty minutes the patient is 
sweating freely. Let this go on till the end 
of the hour: then remove the bottles. The 
patient will continue to sweat for an hour or 
so longer. Then remove the wet blankets, 
without giving the patient cold. Do this 
twice a week, and purge twice a week, con- 
tinuing the mixture. Usually the dropsy will 
subside pleasantly. Do not prick the swollen 
legs, but if necessary put in Southey's drain- 
age tubes, and let the fluid drip off Ihe bed, 
not into it. If dropsical patients cannot, or 
will not stand purging, they usually die. 



CHAPTER X. 



ON INDIGESTION — DIARRHOEA — CONSTIPATION, 
ETC. 

In acute indigestion give 
Cal., gr. iv. 
Pulv. Ipecacuanha, 3i. 

to an adult. Get the offending mass up if 
possible; then in an hour give an ounce of 
castor oil to remove any portion left in the 
bowels. Always look out for acute indigest- 
ion in sharp high fever in children. Give 
them only half the ipecacuanha, or make them 
vomit by tickling the fauces with your 
finger: and mind when doing this they do 
not bite you. 

For diarrJum, first determine its form. If 
due to offending matter in the bowels, and 
the motions, though numerous, are small in 



78 DIARRHCEA. 

bulk, and not accompanied by a sensation of 
relief, give one ounce of castor oil, or better 
still, Pulv. Rhei. ^i. 

Rhubarb first opens the bowels and then 
constricts them. For the diarrhoea from irri- 
tant matter in the bowels it is excellent. An 
ounce of the Tincture of Rhubarb may be 
substituted for the powder. 

If the diarrhoea is profuse in quantity and 
debilitating, it may be well to give adults 

Gretas Prep., 3i. 
•Tinct. Opii., W x. 
Tinct. Catechu, 3 ss. 
Aq. Menth., § i. 

4ta quaque hora. 
or: 

Ac. Sulph. Dil., TIB xv. 
Tinct. Opii, HE x. 
, Inf. Haematoxyli, |i. 
4ta quaque hora. 

To this may be added : 

Cupri'. Sulp., gr. ss. 

Pulv. Opii., gr. i. 

Ext. Haematoxyli, gr. ii, 

at bed-time. If there be much pain, an 
enema consisting of a pint of starch with a 
drachm of laudanum may be thrown up the 
bowel. 
Then there is the diarrhoea of liot weather, 
[The salutary 01 at least non-injurious ef- 
fects of diarrhoea in children during hot 
weather, should be received with considerable 
allowance; for it is often very injurious, even 
fatal.] 

which isa*s well let alone as regards medicine, 
and where a milk diet is sufficient for mild 
cases. Whenever the tongue is furred, 
especially yellow, encourage 'the diarrhoea. 
Do not attempt to stop it. Where there is 
the pale stools of children, without bile, 
known as 'the white scour,' in warm neigh- 
borhoods, give three grains of calomel. In 






UR-EMIA. < y 

diarrhoea in infants, see if there is undigested 
milk curd in the stools. If so, mix the milk 
with some lime-water, and add a dessert 
spoonful of baked flour, or some baby's food, 
to prevent a firm curd forming. Also do this 
when curd is found in the stools of a typhoid 
fever patient. 

When the diarrhoea is uremic in old kidney 
disease, with either complete or partial sup- 
pression of urine, do not attempt to stop the 
diarrhoea until the kidneys act well. To stop 
the diarrhoea without this is to imperil the 
patient's life still further. Put poultices over 
the loins, give a milk dietary with a little gin, 
and 

Pot. Nit. grs. v. ' m 

Liq. Fer. Pernit, TTJ3 xv. 
Inf. Calumbae, I i. 
Quater in die, 

if you must give some medicine. But eschew 
opiates and astringents till the kidneys act 
freely. Always remember that opium acts 
upon the viscera, through their nerve-ganglia, 
as well as upon the intestinal ganglia, or the 
cerebral hemispheres. Many an untoward 
result from opium would be avoided if this 
were more universally recognized. Conse- 
quently, never give opiates carelessly when a 
viscus is gravely embarrassed, and especially 
if the kidneys are the seat of trouble. Keep 
up the action of the skin ; avoid all nitrogen- 
ized food which will throw more waste into 
the blood and add to the gravity of the posi- 
tion. Keep your head clear and cool, and 
remember your physiology, and what has 
been said before in Chapter II., on 'Excre- 
tion,' and you will steer your patient through 
the storm successfully, at least in a majority 
of cases. But do the wrong thing, then dis- 
aster is pretty sure to follow. You may be- 



DIARKHXEA. 



come the object of suspicion with some of 
the friends of the patient, or busybodies, 
who will press upon you another and more 
energetic line of action. This is one of the 
greatest trials to which the young practitioner 
is subjected. But pursue your course un- 
swervingly. 

Then there is a form of diarrhcea which is 
distinctly nervous, and the result of our 'long 
run' expresses, not stopping for a couple of 
hours. Here it is well to give the patient 
Pulv. Rhei., gss the day before, and five 
grains of Pil. Saponis Co. at bedtime, and to 
put him on a milk and corn-flour diet. 

In colliquative diarrh<m, usually accompan- 
ied by profuse sweats, give 

Cup. Sulph., gr. \i. 
Ac. Sulph. Dil., ifcx. 
Inf. Haematoxyli, I i. 
4ta quaque hora, 

with a Cup. et Opii. Pil., at bedtime. Very 
energetic treatment is necessary under these 
circumstances. 

In the diarrhoea of a tubercular ulceration of 
the bowels, the same measures must be 
adopted, with a diet of milk and wheat-flour, 
or arrowroot, thoroughly mixed. 

Then there is the opposite condition of 
constipation to deal with. We will commence 
with less obstinate forms. A person has 
merely irregular action of the bowels. Here 
a pill of aloes and myrrh, gr. iv. at bedtime 
every second night may be enough, with a 
dessert-spoonful of citrate of magnesia the 
next morning in a tumbler three parts full of 
water. Or, Pil. Col. Co. may be required in- 
stead of the Pil. Al. et Myrrh. Such meas- 
ures are sufficient for ordinary constipation 
with a fairly clean tongue. A capital mix- 



CONSTIPATION. 81 

ture is the Mist. Alb., or house-mixture of 

many hospitals: 

Mag. Sulph., 3 ss. 

Mag. Carb., 3i. 

Aq. Menthse Pip. §i., p. r. n. 

When there is habitual persisting constipation, 

make the treatment more active : 

Strychniee, gr. ii. 
Podophylli, 3 ss. 
Pulv. Capsici, 3 i. 
Pil. Col. Co., 3iii.,m. ft. 
In pil. 60 div. 
i. bis in die, 

will form an efficient purgative, or perhaps 
only laxative in severe constipation. If this 
is not sufficient, add black-draught, seidlitz- 
powder, or citrate of magnesia in the morn- 
ing, twice or thrice a week. In very intrac- 
table cases you will find that a combination 
which gives excellent results at first soon 
fails. Then you will have 'to ring the 
changes ;' give Ta-mar Indien, Cockle's pills, 
purgative waters, and then back to the last 
pill, and round again. Very troublesome 
some of the cases are, I can assure you, from 
the patient lacking perseverance. 

[A very good remedy for these chronic 
cases is Farrand, Williams & Co.'s Elixir 
Frangulaxine^ given in dessertpoonful doses, 
before meals for a few days.] 

Then there are cases of constipation with a 
brown-furred tongue, indicating a bilious con- 
dition. The patients will tell you they have 
taken salts, or Eno or Cockle's pills, and been 
freety purged, but are no better. Here what 
is requisite is not a mere stimulant to the in- 
testinal canal, but something to stimulate the 
liver. Consequently the Pil. Cal. Col. Co. 
and Sod. Sulph., etc., so often referred to 
before, are indicated — the mixture every day 
thrice; the pill every other night at bedtime. 
Often it is simply surprising how a mercurial 



82 CONSTIPATION — PILES. 

pill at night will bring away a couple of bile- 
laden stools, and then, presto, the tongue is 
clean. In this, as in other forms of constipa- 
tion, it is well to be patient and persever- 
ing. 

For chronic constipation, rhubarb is exten- 
sively used ; yet it is the most inappropriate 
of all the laxatiVes. It locks up the bowels 
after having opened them, and thus perpet- 
uates the necessity for a laxative. You will 
find, as a matter of practice, that where a 
patient has been long habituated to Pil. Rhei. 
Co., it is enough to stop this, and give Pil. 
Al. et Myrrh, gr. v., at bedtime, and the pa- 
tient soon loses the constipation. Often a 
tumblerful of cold water in the morning is 
sufficient to keep up regular action bowels. 

("A dessertspoonful of Farrand, Williams & 
Co.'s "Elixir" Frangulina, with the water, 
will be found efficacious.] 

The ■patient may complain of piles. If stout 
and plethoric, the loss of blood is rather good 
than otherwise. If the loss causes the patient 
to look pale and ex-sanguine, it must be 
stopped. Keep the bowels well open with 
alkaline saline purgatives. For the local 
treatment, ointments, even made with vase- 
line, a great improvement on ' unguents,' are 
uncleanly. Let the patient wash the bowel 
immediately after the motion has passed, with 
soap and water, by means of a little sponge 
or piece of flannel, till every particle of faeces 
is believed to be removed; then dab the piles 
with a solution of alum, 1 ss to the pint; after 
this return them into the bowel. In a large 
majority of cases this measure will give effi- 
cient relief. The patient should as soon as 
convenient take these different thina-s into the 



DIURETICS. 83 

water-closet, and use them ' immediatly ' after 
the motion has been passed. 

Then there are Renal Troubles, and one 
of these is ' ureteral colic? when a calculus is 
dislodged from the pelvis of a kidney and be- 
comes impacted in the ureter. Then there is 
a severe depressing pain along the affected 
ureter, and drawing up of the testicle on that 
side. Here give opium freely 

Tinct. Opii, Tq, xv. 

every two hours; and keep hot poppj^-head 
poultices or turpentine stupes over the abdo- 
men. The pain may be such that the dose 
of opium must be increased. But as soon as 
the severe pain is over, withdraw the opium 
entirely, or just continue it in ten minim 
doses every six hours. The same line of treat- 
ment applies to gall stones. 

When you find indications for a diuretic, 
you may probably combine several agents, as 

Pot. Citrat., 3 ss. 
Sp. Juniperis Co., 3 ss. 
Tinct. Digital., Tlfl x. 
Inf. Buchu., I i. 
Ter in die, 

and find it very useful. It is, however, dis- 
tinctly a 'pot-hunting' prescription, as ordin- 
arily used. There are two classes of diuret- 
ics, (1) those which increase solids, as pot- 
ash salts, and probably juniper and buchu, 
and to a less extent others; and (2) those 
which increase the bufk of urine, i.e., the 
water. These latter act by increasing the 
arterial tension and from it the excretion of 
water : these are digitalis, which is given in 
cardiac dropsy with a slack pulse, but is of 
little or no use when given with a tense, hard 
pulse, no matter how great the dropsy; bella- 
donna, squill, and scoparius. The two forms 



84 



RENAL DROPSY. 



may be combined as in the foregoing pre- 
scription, but be clear about what you are 
doing; don't give digitalis for lithic acid de- 
posit, or potash where the bulk of urine is 
small. Bat where there is both, combine 
them. Free action on the bowels often does 
much good where there are pink lithates. 
Purgation is always good in dropsy of renal 
origin, whether acute or chronic. 

Acute renal dropsy, is usually brought on 
by cold, and is pretty universal over the 
body, while the urine is smoky or bloody. 
Here, to give the kidneys physiological rest 
is the first matter; therefore the food should 
not consist of beef-tea, but of milk and 
seltzer - water, arrowroot sweetened, fruit, 
corn - flour blancmanges, cream and soda- 
water, or potash-water. Then tha patient 
should be sweated well with Sir James Simp- 
son's bath every day or second day, and given 
Elaterium, gr. 4$, and Pulv. Jalap Co, 5 ss, 
twice a week ; not on the same days as the 
bath, however. For a mixture give: 



Pot. Cit., 3 ss. 
Sp. Chloroform., TT[ xv. 
Inf. Buchu.,5i. 
Ter in die. 

When the active symptoms are over, it is 
well to give fluids freely in order to wash the 
dead masses of epithelium out of the blocked 
renal tubules. But be careful : do not push a 
favourable convalescence off the balance by 
animal food, iron, and tonics, before the kid- 
neys have regained their functional strength ; 
and so overrun their returning power. 

In chronic renal disease, otherwise broadly 
known as 'Bright's disease,' it is impossible 
in a brief work like this to give the student 
any broad rules which can be of much use to 



bright's disease. 85 



him. Probably he will rest his diagnosis, 
wisely or unwisely, upon the presence of 
albumin in the urine. When he does find 
albumin present, his next business will be to 
find its significance — a much more difficult 
matter than to test for and discover its pres- 
ence. How to appraise it I must refer to 
'Auscultation and Urinalysis,' etc. It is 
well when albumin is found to pursue the 
line of relief of the kidneys given above. In 
addition, it may be well to give fifteen minims 
of the tincture of steel three times a day, after 
food. As to the wisdom of giving gallic acid, 
astringents, chalybeate or other remedies, to 
check the outflow of albumin, it is not ap- 
parent; and this plan of treatment is becom- 
ing obsolete. Another exploded plan is that 
of given quantities of albuminoids to meet 
the outgoing waste. This probably kept up 
the albuminuria, which often is markedly 
lessened by a strictly milk diet, and the avoid- 
ance of animal albuminoids. The student 
may smile at the expression 'animal albu- 
minoids,' but as he grows older he will learn 
to recognize the fact that vegetable albumin- 
oids are often more digestible and less dis- 
turbing in their later or remoter actions than 
animal albuminoids. But it is well to remem- 
ber that in chronic renal insufficiency it is 
well to further improve the vicarious action 
of the skin by warm flannel clothing. In the 
first place, this protects the patient against 
sudden chills, which may arrest the action of 
the skin, and thus throw a great demand 
upon the impaired kidneys — a matter fraught 
with imminent danger. The warm clothing 
also keeps up the action of the skin, and so 
lessens the work of the kidneys. 




[Albuminuria often exists without Bright's 
disease; and, in some cases of Bright's dis- 
ease, many tests may be applied before albu- 
min can be detected in the urine.*] 

If called to a case of urcemic coma, purge 
quickly, promptly, and efficiently, with ela- 
terin. Bleeding is often followed" by good 
results'. Ice to the head is of secondary im- 
portance, but may be used after the bleeding. 

When there is dropsy, with or without head 
symptoms, following scarlatina, it is well to 
give, to a six-year-old child, 

Elaterini, giii 1-100. 
Pulv. Jalap. Co., grs. x. 

keep it warm in bed, and on alternate days 

purge and sweat by Simpson's bath; taking 

every care that the child does not catch fresh 

cold. Then give the child 

Pot. Citrat., gr. vi. 

Aq. Anethi, 3 ii- • 
6ta quaque hora, 

and milk and farinaceous food; not beef -tea, 

meat, etc. A little later it may be well to 

prescribe 

Pot. Bicarb. 

Fer. Am. Cit., aa grs. ii j. 
Aq. Menth., 3 ii. 
Ter in die. 

Now we come to a subject of which the 
student usually learns so little at his hospital 
— and feels so awkward about in practice — 
that it will be treated somewhat more in 
detail than the preceding matters. This is 
the question of 'female troubles. ' 

Menstruation is a superfluous wave of nutri- 
tion, and belongs properly to adult life. 
When it becomes established at puberty it is 
apt to limit the growth. It is well, indeed, 
when the catamenia are scanty from puberty 
to adolescence, that is, till the growth is 



*See "Auscultation, Percussion and Urinalysis." 
Leonard. Price, $1. 00. 







MENSTRUATION. 



established. There is, indeed, a direct anta- 
gonism between this rhythmic loss, or ' body 
expenditure,' to use the language of Hermann, 
and growth. One goes on at the expense 
of the other. When a small girl of fifteen is 
freely unwell, it is very improbable that she 
will ever be a well-grown woman. When a 
girl is growing well, and developing into a 
tall, robust woman, she usually is not much 
unwell, and has very little trouble at her 
periods. Her 'generative expenditure' is 
small. When the catamenia are strongly 
developed in a small, weedy girl, she usually 
has leucorrhasa also, and a large generative 
expenditure, though a spinster. 

It is very desirable to thoroughly compre- 
hend this view of menstruation. It consists 
of a cycle; there is the three-weeks interval 
during which there is a gradual ascent of 
arterial tension; the zenith is reached at, or 
just before the time the menses are due; then 
comes the catamenial week, with a com- 
paratively rapid fall of arterial tension. 
Three weeks of rise, and one week of fall; 
and so the menstrual cycle rolls on. This 
rhythmic loss is a w r ave of superfluous nutri- 
tion, which when arrested by impregnation, 
feeds the future organism in the uterus. 

Having grasped this idea fairly, you will 
readily understand why, in underfed girls, 
this discharge does not usually manifest itself 
at the ordinar}- time, but is delayed. The S3 T s- 
tem is in no condition to provide this super- 
fluous wave: it cannot feed itself properly. 
Then, again, /you can see why a sudden 
'growing-fit' in a girl may arrest her menses 
partly, or completely, without giving rise to 
any real cause for anxiety. Also, when 
phthisis shows itself the menses may be 






88 AMENORRHEA. 



arrested. Mothers, especially of the working- 
classes, make themselves often very anxious 
about the disappearace of the menses in their 
daughters. Their reasons may be varied; 
whatever they are, they are very anxious that 
the doctor should restore the flow: they know 
that its reappearance relieves the maternal 
mind. But it is evident that the only means of 
restoring this ' superfluous wave of nutrition ' 
is to feed the organism. Consequently, bit- 
ters to whet the appetite ; iron to make more 
blood; rest from labor, if excessive, are all 
indicated, and when the system can afford 
the rhythmic loss, it shows itself. You will 
prescribe a bitter tonic, as 

Liq. Strychniae Br., ttj iii. 
Ac. Phosph. Dil. IIP x. 
Inf. Gentian., § i. 
Ter in die, 

twenty minutes or half an hour before meals, 
if the appetite is defective. Then give ten 
drops of tincture of steel, or better still, of 
dialysed iron after each meal. Continue 
steadily, and give an aloes and myrrh pill 
every night, second night, or third night, as 
required to act on the bowels. If the patient 
is poor, the strychnine and iron may be given 
together after meals with advantage. Then 
savine is a direct stimulant to the uterus, as 
is aloes. Consequently there is a good old- 
fashioned pill in common use in the country, 
which is well worth your attention; 

Fer. Sulph. Exsic., 
Ol. Sabinae, aa 3 i- 
Pulv. Pip. Nig., 

Pil. Al. et Myrrh., aa 3 ii-, m. ft. 
In pil. 60 dir. i. bis in die. 

This is economical for poor patients, and is 
not a troublesome mass to make up. Food, 
rest, and ha?matics, and your young patient 
will usually do well. If the assimilation is 



MENORRHAGIA. 89 

defective, very often cod-liver oil will improve 
the patient materially. 

In some mature women amenorrhcea is often 
found with leucorrhosa. Here the leucorrhcea 
may be marked, but still there are imperfect 
menstrual periods ; at other times the menses 
are lost in the leucorrhceal discharge. It is 
obvious that it is desirable to check this leu- 
corrhceal discharge whenever it is trouble- 
some, as it is ver3 r debilitating. Direct the 
woman to procure an enema syringe, pear- 
shaped or round, with a nozzle, ivory or gum 
elastic; which is to be preferred to the brittle 
glass syringe, especially for young girls. 
Direct the -patient to wash all the discharge 
away with plain water first ; then to fill the 
instrument with alum water (§i.* to two 
quarts of water) and inject herself with this. 
Be firm about this ; as it is troublesome, and 
women shirk it if not kept at it. You may, 
or may not give a chalybeate tonic, as the 
case requires. 

[The wash in most cases should be warm.] 

W7ien there is Menorrhagia present, another 
line of treatment is required. It is not out of 
place to give 

Tinct. Fer. Perchlor., tth x. 
Liq. Ergot. Ext., 3 ss. 
Inf. Quass., I i. 
Ter in die. 

right away for weeks ; and as a, general line 
this is very good. But at other times it is 
well to remember the interval and the period. 
In the interval give a chalybeate tonic ; good 
food; a hard mattress — you will have little 
prospect of success if the patient sleep on a 
soft feather bed; and improve the general 
health. Two days before the flow is expected 
stop the iron and give 



90 A TENDER OVARY. 

Mag. Sulph., 3 8S. 
Ac. Sulph. Dil., ITPxv. 
Liq. Ergot Ext., 3 ss. 
Inf. Gentian, 
vel Aq. Menth. Pip. , ^i. 
Ter in die. 

Keep the patient cool and quiet, and let her 
take her food — milk, milk- puddings, meat, 
salad, etc., cold. Always keep the bowels 
open, especially at the periods, when they 
are all the better for being a little loose; 
all straining at stool is very bad in menor- 
rhagia. If your patient cannot keep still 
and cool, let her come as near both as 
her circumstances will permit. Then put 
your foot down firmly on all hot tea; 
women stimulate themselves with a cup 
of hot tea; yet in a few minutes there is an 
increase in the loss. The hot fluid has dilated 
the internal blood-vessels, and sometimes 
quite a gush of blood follows. Point this out 
to them : they know it well enough. 

With plethoric females, it is well not to 
give chalybeates, but the mixture given above 
should be taken for some weeks, in the inter- 
vals as well as the periods. When plethoric 
females become amenorrhoeic, depletory 
measures, especially at the time when the 
catamenia should have appeared, had they 
still shown themselves, are desirable; and it 
is well to give warm hip-baths, or even to 
put a leech to the vulva at these rhythmic 
periods. 

A Under ovary. A woman of any age 
during the reproductive period of life, com- 
plains of sickness, nausea, pain under the 
heart, and indigestion, yet her tongue is very 
often clean. On inquiry, you find she has 
vertical headache, is depressed, often cries; 
she is, more or less, constipated; has pain 
when her bowels move, or has pain on mak- 



A TENDER OVARY. 91 

ing water, or both ; has pains in her back and 
groins at her periods; often has difficulty in 
holding her water ; has leucorrhcea, and often 
menorrhagia, with beariDg down pains in the 
womb; and finally often experiences a sensa- 
tion of heat, dryness, and itching in her 
rectum and vagina. The uterus may be 
flexed; but more commonly there is a tender 
ovary. If near the bladder, the pain is 
greatest in making water; if at the side, rest- 
ing on the rectum, the pain is most marked 
when at stool. 

The left ovary is the one usually affected. 
Press on it through the patient's clothes, and 
her face will tell you how she feels, viz. , sick 
and faint. Now what are you to do? You may 
tinker away at her stomach with but very un- 
satisfactory results. Sometimes the vomiting 
leads to the suspicion of chronic gastritis. 
Many a girl has been apparently at death's 
door, and nearly worried the life out of all 
around her, with stomach symptoms, when 
really the matter is reflex— ovarian in origin. 
Put a cantharides blister (2 X 2) over the ten- 
der ovary at bedtime, and next morning it 
will have risen. This usually does not 
cause much discomfort. Then prescribe. 

Sod. Sulphat., 3 1. 
vel Mag. Sulph. 3 ss. 

Pot. Brom. 3i. 

Aq. Camph. 
vel Inf. Gentian, 5 i. 
Ter in die. 

This soothes the ovary, relieves the nausea, 
and keeps the bowels open. If the last is not 
attained, give a Col. Co. pill at bedtime occa- 
sionally. Diet the patient carefully on milk 
and bland food, so as to give the stomach 
little to do. Repeat the blister at the next 
period. Pursue, the treatment and you will 
do your patient good, and get credit. 



92 MENOPAUSE. 



Very often there is menorrhagia in these 
cases which does not yield to the astringent 
and ergot mixture. Be on your guard then, 
and look to the ovaries. Pursue the bromide 
of potassium line. In young girls, where the 
reproductive life is coming on too rapidly for 
their strength, do as above, and you will of- 
ten find the Catamenia dwindle down, or en- 
tirely disappear for a while; during which 
time the girl develops into a well-grown wo- 
man. 

Menopause. Then when a woman reaches the 
change of life called 'the menopause, ' her health 
is apt to be perturbed. There is much mis- 
take prevalent among women on this subject. 
They often allow themselves to fall into a bad 
state of health before this change comes on, 
and, when it does come, they suffer severely. 
I^ow every woman should be put into the best 
possible state to meet this time of trouble, and 
then she will suffer less in that usually stormy 
period which marks the cessation of the re- 
productive period, and the entrance upon 
that calm sexless life which follows this 
change. Give vegetable tonics, carminatives, 
warm purgatives. This is a good pill : 

Pulv. Ipecac, gr. ss. 
Pulv. Pip. Nig. 
Pil. Col. Co. aa grs. ii. 
o. n. 

Very frequently there is much cardiac de- 
bility, with dilatation, and with palpitation 
on exertion ; in which case the pill might con- 
tain: 

Strychniae, gr. 1-30. 
Pulv. Digital., gr. ss. 
Pulv. Pip. Nig, gr. lss. 
Pil. Col. Co. 
vel Pil. AL et Myrrh, grs. ii. 

every day, an hour after dinner. 

Let the patient avoid exertion; and remem- 
ber it is infinite!}' better to keep the patient 



childen's diseases. 93 

quiet than to let her whip herself up with 
stimulants, so as to get about and exert her- 
self. 

There are few matters in general practice 
that are worth more to the student than care- 
ful attention to female troubles. 



CHAPTER XI. 

ON DISEASES OP CHILDREN.— SKIN DISEASES. 

As to children. Examine and watch them 
carefully. If purged, or irritable, see to the 
general health of the mother or nurse, as the 
case may be : to put them right is often to cure 
the child. Often purgatives will act more 
powerfully on the suckling infant than on 
the patient herself. See to the milk; if pos- 
sible, let it come from one cow. Swiss milk 
is a great boon for children in towns, and often 
agrees with children when fresh milk dis- 
turbs them. [This brand we have had large 
experience with, and find it excellent.] When 
griped give them 

Pot. Bicarb., gr. i. 

Ol. Cajeput, W i. 

Syr. Simp. 3 j. 

Aq. Anethi. § i. 

Quater in die. 

When constipated, nothing is better than the 
'ginger-bread nut' made with a few grains of 
jalap powder in each, sold by many chemists 
and confectioners. Why there should exist 
such a prejudice against the use of sulphate of 
magnesia, as a laxative for children, I do not 
know. It suits them well in five-grain doses. 
Sometimes the bowels of children are very ob- 
stinate ; then it is well to prescribe 

Mag. Sulph.., 3 ss. 
Tinct. Sennae Co., 3 ss. Br. 
Aq. Menthae, 3 i ss. 
Ter in die. 



94 children's diseases. 

[One of the best laxatives for children is the 
Elixir of Frangulaxine made by Farrand, Wil- 
liams & Co, of Detroit.] 

Rhubarb as a regular laxative is objection- 
able, for reasons pointed out before. Children 
never can swallow pills; remember that. 

When children are ill-thriven and cachectic, 

they require 

01. Morrh. 
Vin. Ferri,. aa 3 ss. 
Ter in die. 

This 'steel-wine and cod-liver oil' pleases the 
ear of the mother, as well as does the child 
good. 

When aphtha appear on the mouth or throat, 
or there is stomatitis, it is well to give 

Pot. Chlorat., gr. v. 
Syr. Aurant.. : i. 
Aq., 3i. 
6ta quaque hora. 

Borax and hone} r has an established reput- 
ation for these ailments in children. 

Borax (powder of), 3 i. 
Clarified Honey. 1 i. 

Of this a small teaspoonful may be given 
every three or four hours. Mixed with water 
this makes a capital gargle. Either of these 
two measures is good in ulcerated sore- 
throat in children. 

In putrid sore throat, or in diphtheria, it is 
well to prescribe 

Tinct. Fer. 3Iur.. l$ x. 
Pot. Chlorat., gv. v. 
Aq. Anethi. 
vel Aq. Menthse, 3 ii. 

4ta quaque bora. 

and to feed the child as well as possible. 
Quinine and whisky should also be given. 
Sometimes, when the mouth is veiy sore, and 
even drinking milk is painful, it is much 
easier to suck the milk through a tube, as a 
glass rod. In a very severe attack of scarla- 
tina this stood me in good stead. 



SYPHILITIC GROWTHS. 95 

ABSORBENTS. 

Now a few words in reference to those 
remedies called 'absorbents,' which we use to 
remove enlarged glands, and various thicken- 
ings, periosteal and other. 

Each artery carries to every part the nutri- 
tive serum of the blood; a large part passes 
on into the veins; a certain amount remains 
in the tissue for its nutrition ; the surplusage 
passes away by the lymphatics, and so is 
made useful and not wasted. If not so re- 
moved it would lead to disturbance of tissue 
by excess. Consequently, the reader can 
clearly see that when a part is inflamed it is 
useless to resort to absorbents. When all active 
symptoms are gone, and there is neither 
' heat, pain, nor redness ' remaining, only 
' swelling,' the time has arrived when absorb- 
ents will do good: as they will in enlarged 
glands without previous inflammation. You 
may prescribe iodide of potassium internally, 



Pot. iod., 

Pot. Bicarb., aa., gr. v. 
Inf. Gentian, 
vel Aq. Anethi, 5 i. 
Ter in die. 

Then, for external application, use the 
Ung. Iod. Co. , or this with a little blue oint- 
ment (^ii. Ung. Hyd. Fort, and Ung. Iod. 
Co., ^vi.) or 

Hydg. Biniod., 3 ss. 
Vasaline, ?i. 

Under this, as a steady application, thick- 
ening and effusions will pass away. Some 
prefer to paint with tincture of iodine, but 
this is apt to blister. 

[The addition of a little glycerine to tinct- 
ure of iodine will prevent blistering.] 



96 SKIN AFFECTIONS. 

For an effusion into the knee-joint of gouty 
character, it was found well to add some 
tincture of nutgalls. 

Tinct. Iod., 3 v. 

Tinct. Gallae, 3 i". 
will produce a not uncomfortable counter- 
irritation after being painted on twice a day 
for several days, 

1 In all syphilitic growtlis, especially, the use 
of absorbents produces the most gratifying 
results, whether it be a gumma in the brain, 
jra periosteal node; or that terrible neuralgia 
produced by periosteal thickening at a foramen 
through which a nerve passes, which is then 
grasped in a merciless grip. Here nothing 
will relieve the nerve except giving mercury 
and iodide of potassium. 

Liq. Hyd. Bichlor., 3 ss. 
Pot. Iod., 3 ss. 
Aq. Menthae, 5 i. 
• Ter in die, 

which will melt down the periosteal thicken- 
ing and release the nipped nerve. 

NOTES ON SKIN DISEASES. 

There are some matters connected with the 
skin to be mentioned. Eczema, is very com- 
mon at all ages. It is best treated internally 
and externally, by alkalies, 

Pot. Bicarb., 
Sodse Bicarb., aa gr. x. 
Inf. Gentian.. 3 i. 
Ter in die, 

given before meals, and well diluted. To 

this may be added three drops of Fowler's 

Solution, or ten drops of tincture of nux 

vomica, as may be indicated by debility in 

the patient. For an external application 

Sodse Bicarb., | i. 
• Pot. Bicarb., 3 ii. 
Aq., O ii. 

may be kept, applied on strips of linen rag. 



SCABIES. 97 

If in the axilla, oxide of zinc ointment may- 
be used. 

In all chronic skin-affections in children who 
are underfed, badly nourished, or neglected, 
01. Morrh., 
Vin. Fer., aa., 3i. 
Ter in die, 

always does good. 

In herpes it is well to apply the solution of 
the bichloride of mercury, twice a day, with 
a feather or a camel's hair pencil. This kills 
the growing eruption and dries up the already 
formed vesicles. But remember, herpes ia 
not a skin disease proper, but a neurosis. 
The pain may continue after the rash has 
gone, or exist without an eruption at all; as 
I happen to know personally. 

Then you may find scabies. Here it is well 
to order sulphur ointment to be rubbed all 
over the affected parts night and morning. 
The patients should wear the same clothes, 
and not have their bed linen changed during 
the four or five days of treatment. After 
this they should be thoroughly bathed or 
washed; and their clothes and bed linen 
thoroughly purified. This may be done in a 
simple way if more costly contrivances are 
not at hand. Hang up the clothes around, a 
room; close the windows; put down a dish or 
tin containing sand or earth : on this place a 
red-hot shovel, on which place a handful of 
sulphur in powder. Close the door immedi- 
ately, and don't enter the chamber for twenty- 
four hours, by which time the clothes will be 
fairly purified. 

Then, again, there are feet which smell offen- 
sively. Here it is well to advise that the same 
shoes and stockings be not worn continuously, 
but on alternate days. Two pairs of each 
should be worn; and when put off they 



98 



ON FOODS. 



should be exposed to the air, and, if possible, 
to the sun, during the day they are not worn. 
The feet should be washed perfectly clean 
with soap and water at bedtime, and then 
• dabbed ' well with a solution of sulphite of 
soda ( I i to the quart of water). Great per- 
severance is frequently required. 

Cold feet are very common with women. 
They should be rubbed on getting into bed 
with a rough towel, or hair gloves till they 
glow. A hot bottle in bed after this will 
commonly keep up the warmth, and conduce 
to sleep. 

For chapped hands in winter see that the 
hands are thoroughly dried every time they 
are wetted, and some mutton suet well rubbed 
in over the affected parts at bedtime. Vasa- 
line is equally good. 

. When chilblains are actually established, it is 
well to rub them night and morning with 
tincture of cantharides; if ulceration is set 
up, an unguent containing opium (Pulv. Opii. 
9 ss. Vasaline 3 ii.) is useful. 



CHAPTER XII. 

.ON FOODS — APERIENTS AND CATHARTICS. 

Again there is the question of food for the 
patient. Suppose the patient is in bed, 
acutely ill; milk is the food to be given. It 
may be given alone or with seltzer or lime 
water. If there be tympanitis present, give 
the milk with lime-water; the other is too 
gaseous. Then milk may curdle too firmly 
in the stomach; of which curd in the stools is 
the evidence. Here it is well to dilute it as 
above, and to mix with it some biscuit or 
cracker powder or baked flour of any kind 
(a teaspoonful to the pint). 



ON FOODS. 99 



Beef-tea or mutton-broth may be made by- 
cutting a pound of the lean meat to shreds, 
placing At in a quart of cold water for half 
an hour, and then boil twenty minutes. Re- 
move the scum as it rises, season to taste, cool, 
and strain. It should be given cold, and it is 
well to add a little fine oatmeal or boiled 
arrowroot, to give it some better ' food value. ' 

When tlie bowels are loose, stick to milk; 
beef -tea keeps up the purging. 

Another pleasant drink is to dissolve a 
tablespoonful of sugar in a quart of water 
with the juice of a lemon;' then add the 
white of an egg and froth up. 

Apple-water (1 lb to the quart of water) is 
easily made, by boiling the pared apples in 
the water, and allowing it to stand till it is 
cold; and then straining. All these fluids 
may be iced in pyrexia with advantage. 

It is impossible to discuss here the use of 
alcohol; it would occupy too much space. 
This maybe said: do not use it too freely, 
nor forget its value; it is not desirable to dis- 
card its use altogether. 

Always see that the food is put before the 
patient in an appetizing form; everything 
scrupulously clean. Never — and please do 
mind this — never allow any food to remain 
in the sick chamber one moment longer than 
possible. Just that quantity should be taken 
in that can be taken at once ; if any remain, 
let it be removed from the room at once, and 
the same with any fruit, grapes, etc. They 
acquire a taint in the sick-room, and do not 
become more appetizing from being looked at. 
Ice left melting in water in the sunlight; 
some calf's foot jelly in a saucer; a few 
grapes on a plate — how often seen by the 
patient's bedside ! — is not good nursing. 



100 



APERIENTS AND CATHARTICS. 



The ice should be kept in a flannel in saw- 
dust in the coolest place in the house, and 
only a piece chipped off as required. • 

Liebig's extract dissolved, and then allowed 
to become cold, forms a nice drink. So does 
water *in which some rice has been boiled (a 
tablespoonful to the quart), or linseed-tea or 
barley-water; all nourishing. 

When the patient can eat, let the food be 
given in small quantities, so that the patient 
grumbles for a little more. This is much 
better than when too much is sent in at once. 

Now let me insist upon one thing: when in 
acute disease the tongue becomes denuded of 
epithelium (as described in another chap- 
ter), no matter what the particular malady, 
you must attend to the ' prima? viae.' If sick- 
ness comes in, then give 

Bism. Trisnit., gr. x. 
Sod. Bicarb., gr. v. 
vel Pot. Cit., gr. vi. 
Mist. Acaciae, 3 i- 
Inf. Columbae, 3 i. 
6ta quaque hora. 

Give milk sleathed with alkali as above. 
When it becomes very curdled, and there is 
diarrhoea, add ten grains of prepared chalk ; if 
constipation, as much carbonate of magnesia 
as will cover a sixpence to each half-pint of 
milk. Increase the amount if great acidity 
be present, and it is required. If the stomach 
turns rebellious, compromise with it; If it is 
very irritable, it is well to reduce the amount 
taken at once to one tablespoonful at a time. 
If this is not well borne, give a hypodermic 
injection of an eighth of a grain of muriate of 
morphia, and then in half an hour, when the 
morphia is in action, try to get a little milk 
down. 

When there is reflex vomiting, as in preg- 
nancy, try 



LAXATIVES. 101 

• 



Bism. Trisnit., 3 ss. 
Pot. Brom. 3i. 
Mist. Acaciae, 3 i. 
Inf. Columbae, I i.* 
6ta quaque hora. 

Wlien the stomach is irritable and with the 

tongue raw, a simple opium pill 

Pulv. Opii., gr. i. Vel. 
Ext. Opii., gr. ss. 

a little mite of a thing, which, from its bulk, 
does not irritate the stomach, is often very 
serviceable at bed-time; for its local as well 
as its general effect. 

THE USE OF APERIENTS. 

This is a subject about which the student is 
taught very little, and where the older practi- 
tioner usually scores so markedly over his 
juniors, that the matter deserves to be dealt 
with somewhat in detail. It is desirable to 
differentiate the Varied conditions, clearly, 
in order to deal with them intelligently. 

In acute disease .the bowels may not have 
been open for days. Now remember that the 
patient has been on a diet which furnishes 
very little of the material of the faeces, as 
woody fibre, muscular fibre, the parenchyma 
of plants, undigested starch cells, etc. , so that 
there is no great load in the bowels, even 
when they have not been opened for several 
days. If the tongue be clean, and the patient 
does not complain of discomfort, do not be in 
a hurry to act. Where there is rheumatic- 
fever and movement entails pain, be patient. 
If percussion tell that there is a load in the 
the caecum, an enema of warm water, made 
soapy, about one pint or a pint and a half in 
bulk, slowly thrown into the bowels, will 
usually clear the caecum of its contents ; and 
so relieve the patient. Where there is peri- 
tonitis and the vermicular action of the bowels 



102 APERIENTS AND CATHARTICS. 

is arrested by the pain, caused by rubbing 
the inflamed serous layers upon each other, 
give a dose of castor-oil (§i. ad 3 iiss.) or 
olive-oil (§ii. ad § in.), which will cause 
the small intestines to empty themselves 
with the least possible movement. When 
the pain is great, give therewith from twenty 
to thirty drops of laudanum. Where more 
active measures are -required, give simple 
jalap powder from ten to twenty grains. 
This causes little griping, 

A scruple of jalap the third day after con- 
finement, was my father's favorite laxative 
for parturient women, if the bowels were not 
spontaneously open. But in acute conditions 
do not disturb the patient more than you can 
help; and, also, do not run the risk of giving 
them cold by getting them up on the night- 
chair without valid reasons. Remember here 
that what you want is a laxative rather than a 
purgative : you* merel} 7 " wish to unload the 
bowels, and you must achieve this end with 
the least possible discomfort to your patient 

[One of the best laxatives, that operates 
without griping, is Farrand, Williams <fc Co.'s 
"Elixir Frangulaxine." It is made from the 
barks of the Rhamni Frangula and Cathar- 
thicus, with a small amount of senna, rhubarb, 
euonymin, podophyllin and juglandin. Its 
usual dose is a dessert-spoonful before meals, 
to be continued for several days. We have 
used it largely, and have seen nothing its 
superior for the purpose intended.] 

When the tongue is covered with fur, especi- 
ally of a yellow or brown hue, give four 
grains of Pil. Cal. Col. Co. at bedtime; and 
probably next morning the bowels will be 
open, and the tongue clean, or cleaner. 

But do not either be too anxious about the 



PILES, SCYBAL^E. l03 

bowels in acute disease, nor neglect them ; in- 
quire after them every day carefully. 

When there is intussusception of the bowel, 
the bowels usually are locked up mechanical- 
ly. Do not attempt to force them by violent 
purgatives. 

When there is pain referred to the navel, 
while the bowels are locked, and vomiting 
comes on, be on your guard to suspect a her- 
nia, ; or ileus. 

At other times there is a stricture of the colon, 
with a clear resonant gut below the obstruc- 
tion, *and a pouch full of faeces, may be 
water or flatus, above, but usually a faecal ac- 
cumulation. Here it is necessary to do two 
things : relieve the pain caused by the useless 
attempts of the bowels to force the faeces 
through the orifice, by ten minims of laud- 
anum; at the same time liquefy the faeces, so 
that in a fluid form they may pass the barrier 
of constricted gut. To do this, nothing is bet- 
ter than sulphate of magnesia; half an ounce 
in warm water. Give 

Magnesise Sulph., I ss. 
Tinct. Zingiber., 3 ss. 
Tinct. Opii. 3 ss. 
Aq. Ferventis, I ss. 

when cool enough to drink, take at once. In 
the meantime relieve the griping by flannels 
wrung out of hot water, sprinkled with tur- 
pentine, and placed over the bowels. 

Be very careful about opium in thoracic af- 
fections; but in maladies of the abdomen, or 
pelvis, you can use it boldly, especially if 
there exist much pain. 

Sometimes there are scybake lodged in the 
pouches of the caecum ; prescribe the combin- 
ation just given, and also use the soap and 
water enemata, until the hard scybalous masses 
are all washed away. At other times there is 



104 



REFLEX CONSTIPATION. 



an accumulation in the lowest portion of the 
caecum, finding its way into the sensitive rec- 
tum, and setting up the most persistent, agon- 
izing desire to empty the bowels. Here all 
purgatives are useless ; the mass must be dis- 
solved by enemata, or broken up by the han- 
dle of a metal spoon or lithotomy scoop. 

At other times there are piles or anal fissures 
associated with the constipation. The local 
treatment has been given, but the general 
measures are spoken of only in broad terms 
as 'alkaline saline purgatives.' These liquefy 
the faeces, to use a somewhat old-fashioned 
term, and so enable them to pass the painful 
anal orifice with the least possible amount of 
pain. 

Mag. Sulph., |ss. 
Sodas Bicarb., 3i. 
Tinct. Zingib. 
Inf. Gentian, aa, I i. 

with an equal quantity of boiling water, so a 
to make it as warm as the patient can comfort- 
ably drink it, immediately after getting out of 
bed in the morning is a good measure.- 

To give laxatives warm in the morning ear- 
ly, lessens the griping, and makes the bowels 
move more quickly ; thus obviating that an- 
noying matter, the action of the bowels dur- 
ing the day, so socially inconvenient. 

There is one thing I should like to have 
you know about aloes producing piles, though 
the evidence is unsufficient, as believed by 
many. It is a remedy that has been used with 
much success in treating this disease. 

Did you ever hear of or think about reflex 
constipation? Nevertheless it is coming to the 
front, When the vermicular action of the 
bowels causes pain it is inhibited, or arrested 
reflexly. Thus, a swollen, tender ovary, an ir- 
ritable bladder, or a displaced or enlarged ut- 



LIVER PAIN. 105 



erus, are all disturbed by the action of the 
bowels; pain is produced in the act of defe- 
cation, and so the action of the bowels is re- 
flexly held back. The consequence of this is 
that a fecal load accumulates there, and 
.the evil is aggravated; the mass constantly 
pressing on the tender spot and producing per- 
sisting pain, while the strenuous action of the 
gut to pass the obstruction sets up from time 
to time great agony. Here the bowels must 
be opened and kept open, by the above lax- 
ative in the manner given; if necessary giving 
the opiate before they move, to lessen the suf- 
fering. In the same way piles lead to consti- 
pation ; and constipation in its turn entails fur- 
ther suffering. So keep the bowels open : to 
do this, though painful, is to remove the ir- 
ritation of the fecal mass pressing on the mor- 
bid part, and thus aid in its recovering its 
normal condition. 

Pain and tenderness in the lower lobe of 
the liver, or a distended gall-bladder, will like- 
wise arrest the movements of the descending 
colon reflexly, and lead to constipation. Here 
it is well, in addition to the treatment men- 
tioned, to resort to hot fomentations. By 
keeping a wary eye on the cause of reflex con- 
stipation, you will often be successful where 
others have failed. 

Closely allied to this subject is the selection 
of a purgative, where it is necessary to open 
the bowels freely,, and then have them at rest 
for some days after. This is desirable when 
operating for piles, or anal fissure, when sew- 
ing up a lacerated perineum, replacing a dis- 
placed uterus, putting in a pessary; or the 
graver matters of performing lithotomy, or 
ovariotomy, or operating for for vesicovagi- 
nal fistula. In all these, and some other cases, 



106 



LAXATIVES. 



it is eminently desirable to open the bowels 
efficiently, and then to secure quiet in them 
for days after. You have been told that rhu- 
barb first opens the bowels and then locks 
them up. Give twenty grains of Pulv. Rhei. 
or an ounce of the tincture the day before 
operating. This will usually secure the end 
desired. 

Now a few words are desirable on the choice 
of aperients for habitual constipation. Let us 
start with infants and children. Some direc- 
tions have been given which are well worth 
remembering. In addition to these measures 
it is well to give the child oatmeal or 'hom- 
iny' porridge for breakfast, a piece of 'par- 
kin,' (oatmeal and treacle loaf or cake,) a few 
prunes, figs, plain or stewed, or fruit of any 
kind. Regulation of the bowels by a suitable 
diet is always desirable where it is effective. 
Castor-oil is a good though unpalatable laxa- 
tive when one is indicated. Where the con- 
stipation is more pronounced, it may be nec- 
essary to add two drops of croton-oil to the 
ounce bottle of castor-oil, and give a teaspoon- 
ful of this every second morning as required. 
(This forms a capital laxative for adults who 
cannot swallow pills.) 

[The most palatable and efficacious laxa- 
tive for habitual constipation in either child- 
ren or adults, is the Elixir Frangulaxine 
spoken of on page 102.] 

Now as to laxatives for adults. Constipation 
is a common malady existing in various de- 
grees of obstinacy. For ordinary constipation 
a pill of aloes and myrrh every night, or every 
other night, is sufficient. When inoperative 
try Pil. Colocynth. Co. instead. (In all these 
pills five grains is supposed to be the dose 
given. Such a pill is not so large as to offer 



APERIENTS AND CATHARTICS. 107 

obstacles to its being easily swallov^ed.) If this 
is inoperative try a Cockle — very good pills, 
Cockles! Or prescribe, 

Podophylli, gr. \&. 

Pulv. Capsici, gr. ss. 

Pil. Colocynth. Co., gr. iv. 

Capsicum or black pepper will always relieve 
griping — a not unimportant matter — or extract 
of Hyoscyamus (gr. i.) may be used instead. 
Even this may not do. In addition to im- 
perfect secretion from the intestinal glands, 
there may also exist atony of the muscular 
fibre of the bowel in many cases. Here ex- 
tract of belladonna, or strychnia may be 
added. 



Strychniae, gr. l-26th. 
01. Croton Tiglii, gtt. 
Pulv. Capsici, gr. ii. 



gr. i-» 
01. Croton Tiglii, 
ici, gr. 
Pil. Cambogae Co., gr. iii. 

forms a brisk purgative-laxative; but even it 
may be required twice a day in exceptional 
cases. But instead of such potent laxatives, 
it is pleasanter usually to order one of the 
milder pills every night, or second night, and 
some mineral laxative in the morning. The 
morning draught may consist of a dessert- 
spoonful of citrate of magnesia, or Carlsbad 
Salts; or some water, as Pulna, Fredericks- 
hall, or Hunyadi Janos ; or a Seidlitz Powder, 
or effervescing Sulphate of Soda. By vary- 
ing the pill at night, and the morning draught, 
almost any case of constipation may be 
brought around in time. But remember this 
— all such treatment is disagreeable and 
troublesome ; and you must keep your patients 
up to the mark, else they will become remiss. 

Sometimes a tumblerful of cold water on 
getting out of bed in the mornings will attain 
what active measures may have failed to 
achieve. But never abandon the case ; if 



108 



LAXATIVES. 



mild measures fail, try more active ones : fol- 
low them out; sometimes rubbing or knead' 
ing the abdomen on getting up is required. 
The use of suppositories of soap, or hardened 
honey, advocated by Trousseau, are not much 
in use in this country. Nevertheless keep 
your eyes open to these unusual measures in 
very obstinate cases. Sometimes a strong in- 
fusion of senna in black coffee first thing in 
the morning has been found very successful. 
This made the fortune of a Viennese doctor 
in the case of an Austrian princess. 

It is often well to secure an action of the 
bowels night and morning. Any load in the 
lower bowel at night aggravates all pelvic 
trouble, as a large uterus, or ovary, or chordee 
in gonorrhoea. This motion at night is also 
desirable when there is a bitter taste expe- 
rienced in the mouth when waking in the 
morning. This bitter taste is the indication 
of imperfect digestion, and under these cir- 
cumstances there exists usually some defective 
action of the liver. When the epithelium of 
the tongue is stained with bile this is pretty 
certainly the case. Here it is well to give 
laxatives which are also hepatic stimulants. 

Of agents which stimulate the liver, and bring 
away bile-laden stools, are conspicuously mer- 
curials, ipecacuanha, and sulphate of soda. 
Euonymin is also a fairly potent hepatic stim- 
ulant. Now you all know that the liver is 
the furnace in which Waste and spare albu- 
minoids are oxidized into urea and uric acid. 
The bile acids — glycocholic and tauro-cholic 
— are also nitrogenized bodies. The functions 
of the liver and kidneys are closely linked to- 
gether; and in those derangements where the 
urine has a thick sediment and the bowels 
are disordered, the old-fashioned doctor 



APERIENTS AND CATHARTICS. 109 

who shook his head and oracularly uttered 
"Liver!" was not such a fool as it has re- 
cently been the rule to regard him. There is 
nitrogenized waste in the blood; so do two 
things : First, cut down the amount of albu- 
minoids eaten or drank, in order to reduce 
the demand upQn the liver. Then, sweep 
away the waste from the blood by a pill at 
bedtime. 

Pulv. Pip. Nig., gr. ii. 
Pil. Cal. Col. Co., gr. iii. 

and in the morning: 

Sodae Pot. Tart, 31. 
Sodae Sulphatis, I ss. 
Tinct. Zingiberis, 3 ss. 
Inf. Gentian, ii. 

with an equal quantity of boiling water, so as 
to make the draught as hot as can be comfort- 
ably borne. Let this be done twice or thrice 
a week till the tongue is clean. When that 
is done, give the 

Sodae Sulphat, 3 i. 
Sodae Pot. Tart., 1 ss. 
Tinct. Nuc. Vom., gtt. vi. 
Inf. Cascarillae, ?i. 
Ter in die, 

before meals, and the pill twice a week. 

If there be general astJmnia, do not proceed 
to give iron until the tongue is thoroughly 
clean, the water clear, and the appetite good: 
and then commence with two or three drops 
of the dialysed iron once a day after food. 
Here you wish to give the iron as a haematic 
only : if you give it in tonic doses, it will upset 
the assimilative processes^and disagree with 
the patient to a moral certainty. 

In other cases, where there is only slight 
constipation, with deposits in the urine, espe- 
cially after meals, give the old-fashioned din- 
ner pill • 

Pulv. Ipecacuanha, gr. i. 
Pulv. -Capsici, gr. ss. 
Ext. Cinchonae, gr. iii. 
Pil. Al. et Myrrh, gr. i. 



110 



TONIC LAXATIVES. 



every day after dinner. It will be found very 
efficacious. But the student must study his 
cases carefully to see his way clear in these 
disturbances of the assimilative processes. If 
this dinner pill does not act sufficiently, give 
the morning laxative twice or thrice a week, 
so long .as the bowels require it. 

Then as to the union of laxatives with tonics. 
It is well often to combine these two agents. 
In convalescence tonics never act genially if 
there be not at the same time regular and 
sufficient action of the bowels. So add sul- 
phate of magnesia, or sulphate of soda to the 
tonic : 

Blag. Sulphat., 3i. 
vel Sodae Sulphat., 3 i. 

Quin. Sulph. gr. i. 

Ac. Phosp. Dil., HP xv. 

Inf. Gentian. , ?i. 
Ter in die, 

before meals, and ten minims of dialyzed iron 
after dinner daily, will usually give good re- 
sults, or: 

Mag. Sulphat., 3i. 

Tinct. Fer. Mur., HE x. 



Liq. Strychnia?, njj iv. 



Quass, li. 
Ter in die, 

forms a less expensive form of tonic, of much 

utility. 

As other tonics in gouty subjects, or those 

who are rheumatic, or recovering from acute 

gout or rheumatism, it may be desirable to 

give: 

Mag. Sulp^, 3i. 
Pot. Bicarb , 3 ss. 
Fer. Am. Cit., gr. v. 
Inf. Quass, § i. 
Ter in die, 

before meals, with a draught of water. (The 
importance of dilution has been pointed out 
in a previous chapter.) If necessary, give the 
Pil. Cal. Col. Co. once or twice a week at bed- 
time. 



DROPSY. Ill 



But in this use of laxatives, with occasional 
mercurials, avoid the pitfall of letting the 
patient eat with unlicensed abandon. To 
sweep away nitrogenized waste, and so re- 
lieve the assimilative process from the accu- 
mulation of debris, is to improve the appetite; 
just as a fire burns up when the ashes, which 
interfere with oxidation, are poked out. But 
if the dietary be not at the same time regu- 
lated, and the albuminoids cut down, the 
condition is a very undesirable one, and the 
double stimulation of the assimilative pro- 
cesses by too liberal supplies of albuminoid 
food on the one hand, and the exhibition of 
hepatic stimulant-laxatives on the other, will 
in time land the patient in a very unhappy 
state, from which it will not be easy to rescue 
him. This therapeutic plan can cut both 
ways, according to the dietary adopted. 

To stimulate the liver, it is at times well to 
place a large hot poultice over the right side* 
this is a measure the astute student will do 
well to bear in mind. 

When the tongue is very foul, it may be well 
on the second morning of the treatment to 
give 

Calomel, gr. iv. 
Pulv. Jalapae, gr. xv. 

and so open the bowels freely. This usually 
brings away copious bile-laden evacuations, 
after which the tongue cleans under the night 
pill and the day medicine (previously recom- 
mended). Sometimes these morning powders 
have to be repeated at intervals of three or 
four days. 

When in ascites, <rr dropsy, or in the con- 
stipation of meningitis, it becomes necessary 
to resort to cathartics, 



Elaterin., gr. 1-20. 
Pulv. Jalapae, 3ss. 






112 



OX FOODS. 



or: Pulv. Cambogiae, gr. iii. 

Pulv. Pip. Nigr., bss. 
Potass. Bitartrat., 3 ii. 

may be given every second morning, along 
with the appropriate measures, for menin- 
gitis and for dropsy. In all these cases free 
catharsis gives great relief. 

Now, in conclusion, let me tell the student 
to strive to see what are the indications for 
treatment; what is most prominent, pain, 
sleeplessness, fever, collapse, haemorrhage, 
dyspnoea; what in this case calls most im- 
periously for attention. He is taught too 
exclusively, at present, to look at disease 
from a dead-house point of view. To make 
a diagnosis which would be corroborated in 
the dead house is the great matter! Yes, so 
it is at a medical school; but in practice for 
yourself, remember that a living, grateful 
patient, who has got well under your care, is 
worth far, far more to you than any amount 
of accurate diagnosis — which, so far as other 
persons and their opinions are concerned, is 
as voiceless to further your interests as the 
tombstones in the churchyard which mark 
your failures. 



COUNTER-IRRITANT. 113 

CHAPTER XIII. 
a counter-irritant: its action. 

BY JOHN CHIENE, F. R. C. S., E., 

Surgeon Edinburgh Royal Infirmary. 

An irritant acts either directly on the tissues 
to which it is applied, or indirectly through 
the nervous system. The nervous mechan- 
ism is a combination of an afferent impulse 
along the sensory nerves of the part to which 
the irritant is applied. The sensory nerves 
are in connection with a vaso-motor centre, in 
which, as a result of the afferent stimulus, a 
change takes place. The result of this 
change is an alteration in the condition of 
the walls of the blood-vessels which are under 
the command of the vaso-motor centre. 

A mustard blister is applied to the skin at s 
(Fig. 1). An impulse passes along the sensory 
nerve s n. A change takes place at v m, the 
vaso-motor centre ; the result is an efferent 
impulse along the vasomotor nerve v m n, 
the result is a change in the size of the blood- 
vessel b. Dilatation takes place. 

This is the generally allowed explanation 
of an indirect irritant A counter-irritant 
acts also through the nervous system. Let 
us now suppose that we have an inflammation 
of the kidney. The blood-vessels of the kid- 
neys are dilated with a slow flow of blood 
through them. Let the word ''congestion" 
be used for this condition to distinguish it 
from dilatation of the blood-vessels with a 
quickened blood-flow. For this condition let 
us use the word "determination." In both 
of these conditions there is dilatation. In the 
first, congestion, the function of the kidney is 
improperly performed, the kidney is in a state 
of inflammation. In the second, detevmina- 



114 



COUNTER-IRRITANT. 



tion, the function of the kidney is increased. 
When the kidney blood-vessels are restored to 
their normal size there is a condition, which, 




mo 



Fig. 1. 

relatively to the state of determination or con- 
gestion, is one which we may speak of as 
anaemia. 

Congestion is equivalent to dilatation with 
slow flow. 

Determination is equivalent to dilatation 
with quick flow. 

Anmmia is the normal condition of the 
blood-vessels. 

Let us now suppose we have a kidney in a 
state of inflammation with congestion of the 
blood-vessels of the kidney, a mustard poul- 
tice is applied over the skin of the loins at s, 
the result is a change in the v m c, which rules 
the skin-vessels — a change takes place in this 
centre, followed by a dilatation of the blood- 
vessel of the skin b (Figs. 1 and 2). We have 



ITS ACTION. 115 



also a result of the counter-irritant to the skin, 
an alteration in the size of the blood-vessels 
of the kidney, b' (Fig. 2). From a state of 
congestion they pass into a condition of de- 
termination (with a free flow of urine), and 
from that to a normal condition which is rela- 
tively one of anaemia. In consequence of the 
poultice a change has taken place in v m c' 
(Fig. 2) the vaso-motor centre which rules the 
vessels of the kidney. 

What is the nature of this change in 
the vaso-motor centre of the kidney ? 
Before considering this, let us consider 
the physiology of a vaso-motor centre. Let 
me take an illustration from common life. 
A man is driving a horse. The man may 
"feel the horse's mouth," the horse may 

VMC VMrf 




Fig. 2. 

stumble, the man pulls on the reins and sup- 
ports the horse ; the horse may run away, the 
man loses all command. Let the man be the 
vaso-motor centre, the horse the bloodvessel. 



1.16 



COUNTER-IRRITANT. 



When the horse runs away, the man has lost 
all command, — that is the condition in the 
vaso-motor centre in which the blood-vessels 
are congested — dilatation with slow flow — the 
vasomotor centre has lost command of the 
blood-vessels. When the horse stumbles and 
the man pulls it up, that is analogous to that 
condition in the vaso-motor centre in which 
the vaso-motor centre is active, — its function 
is increased when the man feels the horse's 
mouth, that is analogous to a condition in 
which the vaso-motor centre is normal. 

Let us now consider the conditions h» a 
muscle analogous to these' three conditions of 
the vaso-motor centre. A muscle is inflamed, 
the blood-vessels of the muscle are congested 
— dilatation and slow flow ; a muscle is con- 
tracted as in tetanus — the blood-vessels are 
dilated with quick flow determination — a 
muscle is at rest, there is anaemia relatively to 
the state of congestion or determination. 

To take another example, in the brain. 
When inflamed, there is congestion, dilata- 
tion, and slow flow, — in thought, the func- 
tions of the brain are active ; the blood-ves- 
sels of the brain are dilated with quick flow 
determination. The brain is at rest as in sleep, 
the blood vessels are anaemic. 

There are then three conditions*ih an organ, 
(1) at rest, normal ; (2) its functions in- 
creased ; (3) its functions abrogated. These 
three conditions are associated with an altera- 
tion in its blood supply. Physiologists tell 
us that this is true of a muscle and of the 
brain. May it not also be true of a vaso-mo- 
tor centre ? In it we have the three condi- 
tions — the function of the vaso-centre ma}* be 
normal, the function of the vaso-moior centre 
may be increased, or it ma}' be lowered. In 



ITS ACTION. 117 



the first we have relative anaemia of the cen- 
tre ; in the second we have determination of 
. blood to the centre ; in the third we have con- 
gestion of the centre. 

Let us now apply these considerations to 
the counter-irritant in the case of the inflamed 
kidney. 

When the kidney is inflamed the blood-ves- 
sels of the organ are dilated with slow flow 
congestion— the vaso-motor centre has lost 
command of the blood-vessels of the kidney 
— its function is in abeyance — it is congested. 
If we now apply a counter-irritant to the skin, 
and, as . a result through the sensory nerves, 
we have a change in the vaso-motor skin cen- 
tre with a corresponding change in the blood- 
vessels of the skin. There is an increase 
in the amount of blood in the vaso-motor 
centre. There is a flow of blood to the vaso- 
motor centre, the neighboring parts are bled, 
the vaso-motor centre of the kidney is in close 
anatomical relation to the vaso-motor centre 
of the skin over it. The kidney vaso-motor 
centre, which is congested, is bled; it supplies 
blood to the skin centre — the result is that the 
vaso-motor kidney centre gradually regains 
its function. The kidney vesssels, as a con- 
sequence of the change in the vaso-motor 
centre, pass from congestion to determination 
— a free flow of urine takes place, and from de- 
termination to one of relative anaemia — the 
kidney is restored to a normal condition. If 
this explanation is verified by further inves- 
tigation and experiment on animals by those 
who have the power to make such experi- 
ments, we shall then be able to throw aside 
all such terms as a change in tone, terms 
which mean nothing. I desire to express my 
conviction that a change in function of an 



118 



COUNTER-IRRITANT. 



organ, be it a muscle, the whole brain, or a 
part of the brain, as a vaso-motor centre, 
must be accompanied by a change in the ana- 
tomy of the part. When we remember the 
temporary nature of the improvement that 
takes place on the application of a counter- 
irritant requiring its repetition or continuance 
in order that the result may be a permanent 
improvement, I think we must look to altera- 
tion in the blood supply as the most probable 
anatomical lesion. The organ at issue is so 
minute, that it may be only the blood plasma 
which bathes it, which may be altered in a 
moment. The withdrawal of a single minim 
of blood plasma from a vaso motor centre 
may have an effect on that organ equivalent 
to the withdrawal of a couple of ounces of 
blood from the biceps muscle. 
• I have tried to show that when we apply a 
poultice over the loin in inflammation of the 
kidney, the good result which follows is in 
part due to a bleeding of the vaso-motor kid- 
ney centre to supply blood to the vaso-motor 
skin centre, which is in anatomical and phy- 
siological connection with the kidney centre. 
This bleeding at a (Fig. 3) is microscopic; the 
vaso-motor organs at the proximal end of the 
nervous mechanism are microscopic. 

The counter irritant in the case of the kid- 
ney, acts however, in another way. We can 
inject the skin of the loin through the renal 
artery, there is a free arterial anastomosis be- 
tween the blood-vessels of the kidney and 
the skin over it. The vessels of the skin are 
dilated, the blood-vessels of the kidney sup- 
ply the blood. There is, therefore, also a 
macroscopic bleeding at b (Fig. 3). The action 
of the counter-irritant is twofold in the case 
of the kidney, a microscopic bleeding at a, re- 



ITS ACTION. 119 



lieving vascular tension indirectly through the 
nervous mechanism ; there is also a macro- 
scopic bleeding at b, relieving vascular tension 
directly. 




It may be asked, is it necessary to theorize 
about the microscopic bleeding at a ? Will 
the macroscopic bleeding at b not be sufficient 
to explain the good result that follows ? If 
we take the lung, when it is in a state of in- 
flammation, a poultice over the chest relieves 
the condition, and in this case there can be no 
direct macroscopic bleeding ; as there is no 
direct anastomosis between the lung-vessels 
and the vessels of the chest-wall, the good 
result which follows must be due to the mi- 
croscopic bleeding at a. Indirectly the lung 
vessels may be bled to supply the' blood to 
the dilated vessels in the chest-wall, but this 
must act through the whole mass of blood, 
and, although it must be taken into account 
in explaining the good result, still it cannot 
be the main factor. In the case of the lung, 
the main factor must be at the proximal end 
of the mechanism, the bleeding must be mi- 



120 



COUNTER-IRRITANT. 



croscopic, the lung centre being bled to supply 
the skin centre. 

The counter-irritant action then is twofold, 
— in all cases the microscopic bleeding takes 
place ; in some cases the macroscopic bleed- 
ing takes place, directly drawing blood, as 
in the kidney ; in other cases the macro- 
scopic bleeding, as in the lung, may act in- 
directly through the whole mass of blood 
in the body. 

The counter-irritant comes under the 
class of remedies which relieve or cure 
inflammation by blood-letting, by relief of 
vascular tension, directly or indirectly, 
as the case may be. Counter-irritants 
may act locally or generally. A blister 
or a poultice is a local counter irritant. A 
diaphoretic, a diuretic, a purgative, is a gen- 
eral counter-irritant. Take the case of a dose 
of castor-oil ; it has been shown when castor- 
oil is administered, that the blood-vessels are 
dilated in the intestinal mucous membrane. 
The castor-oil may act as a direct irritant on 
the vessels, or indirectly through a nervous 
mechanism — it matters not which ; in either 
case the intestinal vessels are dilated. The 
blood is drawn from other organs to supply 
the blood to the intestinal vessels. So also in 
the case of the diaphoretic to the skin vessels, 
and the case of the diuretic to the kidney ves- 
sels. 

It is not to be forgotten that these remedies 
will also relieve vascular tension by withdraw- 
ing the serum of blood from the mass of 
blood ; in this way still further relieving vas- 
cular tension. 

Metastasis may be explained in the same 
way. The parotid is inflamed, its vaso-motor 
centre is congested, the congestion spreads 



DIET FOR THE SICK. 121 

by continuity to neighboring parts and impli- 
cates the testicle centre. 



CHAPTER XIV. 

DIET FOB, THE SICK. 
Contributed by MRS. EMMA DRANT. 

Matron of the Hospital of the Michigan College of 
Medicine, Detroit. 

RESTORATIVE JELLY. 

J^ box Cox's gelatine; 1 tablespoonful powdered 
gum arabic ; ^ pint port wine; juice of 1 lemon; 3 
tablespoonfuls sugar; 2 cloves. 

Soak all together 2 hours. Put the bowl of 
ingredients in a basin of boiling water (to 
keep from burning.) Stir until the mixture 
has melted, boil a moment more, then strain 
through flannel jelly-bag, and put to cool. 
The port wine may be replaced by any other 
liquor or beef essence if preferred. If beef 
essence is substituted omit lemon and sugar 
and use salt. A spoonful at a time is suffi- 
cient for patients too ill to swallow much. 

plum porridge (Excellent for Bowel Com- 
plaint.) 
Into 1 qt boiling milk stir 2 teaspoonfuls 
of flour, previously mixed with a little cold 
milk. Put in a handful of raisins and a little 
grated nutmeg. Boil 20 minutes, season with 
salt and strain. Do not serve the raisins. 

CLEAR BEEF SOUP. 

Cut a small quantity of beef very fine, soak 
in three times its bulk of cold water for two 
hours. Boil in bath two hours, then clear 
with white of egg. Add a clove, when cook- 
ing, if desirable. 

Caution. — Never let meat boil fast; keep 
it just at the boiling point and skim often 



122 



DIET FOR THE SICK. 



SHERBET, OR WATER ICE. 

Make some very strong lemonade. Take an 
ordinary tin pail, put it into a wooden bucket 
the bottom of which has been lined with a 
mixture of nine parts ice and 1 part coarse 
salt; pack ice and salt all around the pail, 
being careful not to drop any salt mixture 
into it. Finally, put your sherbet into the 
pail ; let it stand for a while, then stir from 
the sides all that has thickened, cover until 
quite thick then beat hard with a spoon. 

EGGS. 

An egg beaten light, and mixed with a glass 
of milk, is very good for an invalid, who can 
eat nothing solid. 

The yolks of eggs, when cooked, should be 
eaten by invalids, the white being less easily 
digested. 

BEEF JUICE. 

Broil a juicy round steak (cut thick) ; when 
seared, cut it into small pieces, put it in a 
lemon squeezer and squeeze out all the juice 
while hot. Add salt. When serving immerse 
the vessel, containing the juice, in a pan of 
hot water for a few minutes. 



BROILED STEAK. 

Sprinkle a very hot frying pan with salt (no 
butter), then sear both sides of your steak and 
serve. 

MUTTON BROTH. 

1 tt» neck of mutton, 
1 tablespoonful barley, 
1 qt. cold water, 
Salt and pepper to taste. 

Remove all fat from the meat; cut the meat 

into small pieces — put lean meat, barley, 

bones and water to boil ; when it comes to the 

boiling point, skim off all the fat, cover and 



DIET FOR THE SICK. 123 

set back where it will only bubble for 3 hours ; 
add seasoning and boil 10 minutes longer. 
The meat is perfectly digestible. 

Note. — Take fat off of all soup for invalids, 
when the mixture is cold; or, if it is necessary 
to use at once, skim with, fine blotting paper. 

REFRESHING DRINK IN FEVER. 

Four ounces tamarinds, four ounces raisins ; 
boil in three quarts of water, slowly, for fif- 
teen or twenty minutes, or until the water is 
reduced nearly one fourth; then strain, while 
hot, into a bowl with a lemon peel in it. When 
cool, use as a drink. 

TO MAKE GRUELS. 

Two tablespoonsf ul oat or corn meal stirred 
into one cup of cold water; then add one and 
one-half pints boiling water. Boil slowly 
one-half hour. Season with salt. Can be 
eaten with sugar and milk if desirable. 

BEEF TEA, WITHOUT HEAT. 

One-third pound lean beef, minced very fine ; 
place it in fourteen ounces soft water (cold) 
to which has been added a pinch, or, about 
eighteen grains table salt and three or four 
drops muriatic acid ; stir with a wooden spoon, 
and set it aside for an hour, stirring occasion- 
ally ; then strain through a gauze or sieve and 
wash the residue left on the sieve with five 
additional ounces of cold soft water, pressing 
it so that all the soluble matter will be removed 
from the residue. Mix the two strainings and 
then the extract is ready for use. Drink freely 
every two or three hours. 



124 



DIET FOB, THE SICK. 



BLACKBERRY AND WINE CORDIAL. 

{Useful in diarrhoea or bowel troubles.) 
To one-half bu. blackberries, well mashed, 
add a quarter lb. of allspice, two oz. each of 
cinnamon and cloves, pulverized well. Mix 
and boir slowly until properly done. Strain 
juice through flannel, and add to each pint 
of juice one lb. loaf sugar. Boil again for 
as long as possible without burning. Take 
off, and while cooling, add one-half gal. best 
Cognac brandy. 

Dose. — For adult: one-half gill, to a gill; for 
a child, a teaspoonful or more according to 
the age. 

TO COOK RICE. 

Soak the rice seven hours in cold water and 
salt; have ready a stew pan with boiling water, 
throw in the rice and let it boil briskly ten 
minutes ; never stir. Drain it on a colander, 
cover, and let it stand a few minutes by the 
fire. The grains will be double the usual size, 
and much easier to digest. 

CHICKEN BROTH. 

Take a rather old chicken, crush it with a 
mallet or rolling-pin, until it is in rags (bones 
and flesh), then boil in an earthen vessel until 
the strength is entirely extracted; season with 
salt. 

APPLE SNOW. 

{A dainty dish for convalescents.) 
Take a small sauce dish of cold apple sauce; 
beat it very smooth with a wooden spoon ; then 
beat the white of an egg until you can turn 
your plate over without dropping the egg off. 
Mix egg and apple sauce gradually and beat 
briskly until it is stiff. A dash of lemon ex- 
tract improves the flavor. 



DIET FOR THE SICK. 125 



MARYLAND OR BEATEN BISCUIT. 

Flour and water, with a pinch of salt. Make 
a paste as thick as for pie crust; take your 
rolling-pin or a mallet and beat for an hour; 
cut into cakes and bake. Easily digested by 
invalids. 

CRACKER GRUEL. 

6 Tablespoons fine cracker crumbs. 
1 Quart milk. 
I Teaspoon salt. 

Put crumbs and milk into farina boiler and 
let it come to a boil; add salt and cook two 
minutes more. 

VICTIMIZED CHOPS. 

Trim all fat from a loin chop, cut very thick, 
lay it between two very thin chops, like a 
sandwich. Broil until the outside chops are 
burnt, the inner chop will be done and ex- 
ceedingly juicy. Serve on a hot plate. 

SHIRRED EGGS.. 

Butter a sauce dish, and into it break two 
eggs; put into the oven until the white sets; 
serve in the saucer with salt and butter. 

WHITE CUSTARD. . 

Separate the yolks and whites of three eggs; 
use the whites only. Take, also, one-fourth 
teaspoonful of salt, two tablespoonsful of 
sugar. Give a light grating of nutmeg, then 
one pint rich milk. 

Beat sugar, whites, salt and nutmeg; then 
add a little milk, and beat thoroughly; then 
add the rest of the milk. Bake in cups, set 
in a pan of water. When firm in the centre, 
put on the ice to cool. 



126 



DIET FOR THE SICK. 



LEMON SYRrP. 

5 Lemons. 

8 Pounds crushed sugar. 
3 Ounces citric acid. 
3 Quarts water. 

Roll the lemons; peel and squeeze them. 
Use only one-half the peel. 

Boil with sugar and water fifteen minutes, 
having removed all seeds. Pour into a jar, 
put in the acid while hot and stir until dis- 
solved. Let stand until next day. Bottle 
and keep cool. 

A tablespoonful to a glass of water makes 
delicious lemonade. 

CRACKER PANADA. 

Soak a cream cracker in a pint of water 
until it has absorbed almost the entire quan- 
tity. Sprinkle cinnamon and a little sugar 
over the top, then pour over the whole two 
tablespoonsful of wine, or other liquor. 

REMEMBER : 

When invalids are convalescing they are 
more particular about the minutiae of their 
diet than when well. 

Always serve as small a quantity as possible 
at once. 

Let everything be neat and clean on the 
tray. Do not spill the tea in the saucer nor 
fill the gruel bowl more than one-half full. 

When you make toast always roll it on your 
bread-board with the rolling-pin, to crush the 
crust ; then put it on a hot plate in the oven, 
for a minute; cover with another hot plate 
and serve. 

If you serve boiled eggs in 'the shells and 
wish to keep them from cooking hard after 
they have boiled three minutes, just take the 
back of the bowl of a teaspoon and crack one 
end a little, to stop the cooking process. 



DIET FOR THE SICK. 127 



DRINK IN CASES OF DIARRHOEA. 

A coffee-cup full of browned, coarse corn- 
meal, boiled in sufficient water to make it as 
strong as coffee. Drink as warm as possible. 

EGG-NOG. 

Strengthening for Convalescents. 

1 egg. 

1 table spoonful white sugar. 

1 " water. 

1 " milk. 

1 " wine or other liquors. 

Beat the white of the egg to a froth; then 
beat in the sugar; next the yolk, then the 
milk ; wine and water. 

ICE CREAM FOR INVALIDS. 

As ice cream is sold in the stores it is too 

sweet for an invalid's palate, so we give a 

receipt for making it "just right." 

1 cup of milk. 

1 teaspoonful arrow root. 

1 pint cream (not very thick). 

M cup of sugar. 

}4 teaspoonful essence (to suit taste). 

Boil the milk until it begins to skin, then 
add dissolved arrow root. Boil a few min- 
utes longer and set aside to cool; when cold 
add the other ingredients and freeze. 

CURRANT JELLY. 

Like ice cream, the ordinary currant jelly 

is too sweet for invalids, but this recipe may 

please any invalid. 

1 pint currant juice. 
\\& pints cold water. 
1 tablespoon sugar. 
1 lemon (juice only) . 
1 tablespoonful Cox's gelatine. 

Pour a half pint of boiling water on the 
gelatine to dissolve it, Add the other ingre- 
dients and set on the ice to freeze. 



128 



DIET FOR THE SICK. 



GELATINE. 

I buy the domestic gelatine in sheets from 
the druggist. To make a small quantity for 
a "bonne bouche" for an invalid, I take 3 
sheets, orl oz., dissolved in 1 pint of warm 
water. When it is thoroughly dissolved I 
bring it to a boil, adding one half cup of 
sugar, the juice of a lemon, and the white of 
an egg. Beat it well, and put on ice. Re- 
member, a tablespoonful served in a dainty 
dish may persuade your patient to ask for 
more; but a bowl -full will never accomplish 
that purpose. The eyes of invalids some- 
times seem to act as stomachs to digest be- 
fore the mouth receives. 

OYSTERS ON ICE. 

Take a piece of ice with square edges, or 
flat edges, just large enough to lay on a soup 
plate; make a cavity in the top of it, by put- 
ting a piece of stone or iron red hot on it; 
drain off the water and continue to apply the 
hot iron until you have a space large enough 
to hold three or four oysters. The oysters 
should be. ready seasoned to suit the invalid, 
then placed in the ice "dish" and the soup- 
plate so covered with ferns, or vine leaves, 
that only the block of of ice, with the oysters, 
is visible. If the ice slips a napkin can be 
folded under it hidden, like the plate, with 
leaves. 

PLAIN OMELET. 

1 egg- 

1 pinch of salt. 

y% tablespoonful of milk. 

A piece of butter the size of a hickoiynut. 

Beat the egg very light; add salt and milk. 
Have the pan very hot ; put in the butter and 
then the egg. Shake the pan until the egg 
begins to settle, then brown well; run a 
broad bladed knife under it, fold one half 
over the other and serve hot. 



DIET FOR THE SICK. 129 



ARROW ROOT GRUEL. 

. 1 pint milk. 
1 teaspoonful arrow root. 
Salt to taste. 

Let the milk just come to a boil; mix the 
arrow root smooth with a little cold milk 
and then stir it into the boiling milk and add 
a little salt. Cook gently 10 minutes longer. 

WINE WHEY. 

Drink for a wry sick person. 
Let 1 cup of fresh milk come to a boil. Stir 
in one half a wine glass of slierry wine. Boil 
a moment longer, strain as soon as it curdles. 
Put on ice to freeze ; or, if used as a warm 
drink, serve at once. 

LEMONADE. 

Some people might consider the making oi 
lemonade such a simple thing that they would 
laugh at my giving directions for it ; but I 
have so often found a "glass of lemonade" to 
mean water with slices of lemon floating in it 
that I know some people may be taught if 
they will try. 

"Roll a lemon until it is perfectly soft; 
squeeze the juice into a glass, remove all 
seeds, add two teaspoonful of sugar and fill 
the glass with water and stirring well, then 
serve. 

POTATO PUFF. 

Two cupsful mashed potatoes; two table- 
spoonsful melted butter. Stir these with a 
seasoning of salt to a light, fine, creamy bat- 
ter. Beat two eggs separately, and add with 
six tablespoonsful of sweet cream. Then 
beat altogether well and lightly. Pile in an 
irregular, jagged form in a dish and cook in 
quick oven till nicely colored. 



130 



DRINKS FOR THE SICK. 



WINE JELLY. 

\y 2 packages Cox's gelatine. 
1 pint cold water. 
Juice of 3 lemons. 
Rind of 1 lemon. 

Let gelatine soak in the water one hour; 
then add three pints of boiling water and one 
pint of wine (sherry usually, though any kind 
may be used) and two pounds white sugar. 
Run into cups, or bowls, and let it stand in a 
cool place till it hardens. (Strain all through 
a fine sieve before slicing in the rind of the 
lemon). 

Oranges, or even fruit pieces of any kind 
may be used in place of the lemon. 

ORANGE WHET. 

The juice of one orange to one pint of 
sweet milk. Heat slowl3 r until curds form, 
strain and cool. 

EGG LEMONADE. 

White of one egg, one tablespoon pulver- 
ized sugar, juice .of one lemon, one goblet 
water. Beat together. 

SAGO MILK. 

Three tablespoonsful sago soaked in a cup 
of cold water one hour; add three cups boil- 
ing milk; sweeten and flavor to taste. Sim- 
mer slowly a half-hour. Eat warm. 

BAKED MILK. 

Put a half gallon of milk in a jar, and- tie 
it down with writing-paper. Let it stand in 
a moderate oven eight or ten hours. It will 
be like cream, and is very nutritious. 

PUNCH, WITHOUT LIQUOR. 

Take the juice of six oranges and six lemons, 
adding sugar to suit the taste. Put to this a 
quantity of pounded ice and some sliced pine- 
apple, pouring over it two quarts of water. 
This is an agreeable summer beverage for any- 
body, sick or well. 



ERRORS IN NURSING. 131 



CHAPTER XV. 

ERRORS IN NURSING. 

[The Editor would especially commend 
the following article from ihe pen of an 
English physician. Having spent some nine 
or ten months of the past two years on his 
back, owing to a run and relapses from a 
fever, he has abundant reasons lor endorsing 
the several point's in the article that he has 
taken the liberty to italicise.] 

Do not walk on tiptoe, for this, in addition 
to its unusual elaboration of the gait, invaria- 
bly causes a certain amount of creaking. 

Speak in low tones, but don't whisper; a 
whisper will often awaken a sleeper who 
would not be disturbed by ordinary conver- 
sation; and never say "Hush !" Let your 
clothes and foot covering be of as noiseless 
and unobtrusive a character as possible, and 
instead of gliding and tottering about like a 
rickety ghost, do not hesitate to walk. If 
you have occasion to say anything in the room, 
say it so that the patient can hear it if he wishes, 
and do not let him be aware of your conspir- 
ing privately with others, especially at the 
door. 

That door has much to answer for. If it 
be visible from the bed,- people open it cau- 
tiously, put their heads in, and slowly with- 
draw again. If, as is more frequently the 
case, it is screened by the bed curtains, mys- 
terious openings and shuttings are heard, un- 
attended with any ingress or egress, and sotto 
voce colloquies go on outside. When you en- 
ter, do so honestly and at once; do not spend five 
minutes in turning the hnndle, like a house- 
breaker, thereby producing a series of irritat- 
ing little clicks, finally terminating in a big 
snap, with which the door flies open. If the 



132 ERRORS IN NURSING. 

latch be at all rusty, a handle that is slowly- 
wound back in this way will often stick, and 
either require to be rattled back into position, 
or, if left as it is, may start back suddenly 
after a time of its own accord with a report 
like a pistol shot. 

It is always well to recollect tliat it by no 
means follows that a sick person is asleep because 
his eyes are shut; he may be acutely conscious 
of all that is passing in the room, though un- 
able or unwilling to make any sign; and 
nothing can be more maddening, under such, 
circumstances, than to have people hush-sh- 
ing and whispering around, and creaking 
about on the tips of their toes. We have all 
sympathized in our hearts with poor Sir 
Leicester Dedlock when his tongue was 
smitten with paralysis, with his sister con- 
stantly bending over him with clasped hands 
and murmuring, " He is asleep! " till, goaded 
to desperation, he makes signs for his slate 
and writes, "I am not." 

Never stand at the foot of tlie bed and look at 
the patient. While talking to him it is better 
to sit by the side of the bed, and as near the 
pillow as possible, so that you may converse 
easily, while your face and body are turned 
in the same direction as his. By this means, 
you can make all necessary observation of his 
features without enforcing the arrest of his 
. eyes to your own, which is so embarrassing 
and disagreeable to one lying in bed, and is 
almost unavoidable when facing him. Keep 
him in as comfortable a position as possible, 
by all means, but don't be too demonstrative 
in smoothing the pillows and little offices of 
that sort. Fidgety attentions will worry 
him, and do him more harm than downright 
neglect. 



ERRORS IN NURSING. 133 

When you are sleepy, it is better for your 
charge, as well as for yourself, that you should 
go to bed at once, and get that repose in slum- 
ber to which you must succumb eventually, 
however strong your devotion may be, and 
however great the interests at stake. It is 
not necessary to dwell here on the prudence 
of economizing your strength, that you may 
be capable of greater or prolonged exertions, 
should the need for them arise, or to look at 
this detail from the point of view which 
affects yourself. But in any case, you can 
be of little or no service, worn out with 
fatigue, and in a condition more akin to som- 
nambulism than vigilance, and the spectacle 
of a nodding, dozing nurse is neither soothing 
nor reassuring to the sufferer; while, if you 
be one near and dear to him, he will be tor- 
mented with anxiety lest you should impair 
your own health on his account. In such a 
case as this, you cannot do better than lie 
down comfortably on a sofa or bed where he 
can watch you, and there have a good nap — 
for his sake. 

Some people have a great notion of 
"tempting the appetite'' by the suggestion 
of all manner of eatables and drinkables, or 
by bringing them ready prepared to the bed- 
side experimentally. This, no doubt, is very 
well at times — during convalescence, for in- 
stance ; but as a medical man, I am persuaded 
that it is a mistake in the earlier stages of an 
illness, when, all food is loathed alike, and 
the creation of an appetite is an impossibility. 
The only thing to be done is to impress on the in- 
valid the necessity of taking lohat is ordered for 
him at stated times, just as he takes his medicine; 
and it should be prepared on the sar/fb footing as 
a medicine — with the understanding that it is 






134 



ERKOES IN NURSING. 



a nauseous dose, and must be presented in a 
form that will admit of its being swallowed 
as compactly and rapidly as possible. It is 
worse than useless to employ flavoring matters at 
this stage, with the idea of making anything 
palatable; if you can render his food abso- 
lutely tasteless* you will do far more for him. 
And beyond this forcible administration, so 
to speak, of a certain amount, I think little 
good is gained by suggesting this or that 
delicacy, in the hope that your patient may 
be induced to "fancy" something. We may 
take it for granted that when he feels inclined 
for anything he will ask for it spontaneously; 
and the promptings of nature are more likely 
to lead him to a choice of what is best for 
him, than our string of suggestions. I have 
frequently observed that when sick people 
have mentioned a desire for any special food, 
they almost invariably eat of it when it is 
procured; whereas it often happens when 
they have been persuaded to assent to some- 
thing which has been proposed, the inclina- 
tion — if it ever existed — has passed away be- 
fore the dish or article can be brought to 
them. 

I say, " if it ever existed; " for there is no 
doubt that a patient often yields to suggestions 
in sheer extremity, simply for the sake of peace. 
I happened to be in a sick room the other 
day, when a relative arrived on the scene. 
She had been warned to repress all emotion, 
and succeeded very well ; but her tender soli- 
citude was wholly irrepressible. I am sure 
that she asked at least twenty questions in 
less than a minute, until the unhappy sufferer 
writhed under them. "Shall I raise j r onr 
head a little? Will you have another pillow? 
Wouldn't you like your head a little higher? 



ERRORS IN NURSING. 



135 



Let me fan you. Will you have the blind 
up? What can I get you? Some arrowroot? 
Do try some! I am sure you will be more 
comfortable with another pillow. Will you 
have one? — yes; do! I'll go and get one. 
Will you have a cup of tea? I'm sure it 
would do you good. A cup of tea won't take 
a minute," etc. The cup of tea has been a 
dreadful instrument of torture in the hands 
of well meaning people, who would not 
knowingly have teased a fly. 

These are small things, you will say. But 
a small thing in health is often magnified to a 
grave matter in sickness, and the sum total of 
them all may be as serious in their effect as 
the disease itself. It will be seen that the 
few points upon which I have laid stress are 
such as are calculated to promote tranquility 
of mind — which, indeed, is half the battle in 
medical treatment. It is generally conceded 
that a trained nurse, who has no interest in 
the patient beyond that which the duties of 
her office impose, is better fitted to expedite 
his recovery than those who are bound to 
him by ties of affection,, however welcome 
their presence may be in the hour of afflic- 
tion. 



INDEX. 



Absorbents 95 

Acute indigestion 10 

pain ' 39 

Ague 54 

Albuminoids 15 

Albuminuria 86 

Alteratives ■ 25 

Amenorrhoea , 89-88 

Anal fissure 104 

Anaemia 47-49 

Antiseptics 52 

Aperients 98 

selection of 106 

use of 101 

Aphthae in mouths of children 94 

Apple snow 124 

Apple water U9 

Arrow- root gruel 129 

Artificial digestion 18 

Ascites : Ill 

Assimilation and excretion 13 

Astheenia, general 109 

Asthenic inflammation 42 

Badly nourished child »4 

Baked milk 130 

Beef juice 122 

soup 121 

tea -. 99 

without heat 123 

Bitters 16 

Blackberry cordial 124 

Blood poisons 52 

Body temperatures 28 

Bowels, loose ? 99 

Bright's disease 24-85-84 

Bronchitis 40-72 

Broiled steak 122 

Bubo 38 

Cachexia in children 94 

Calculus (renal) 83 

Catarrhal fever 58 

Cathartics 98 

Chicken broth 124 

Chilblains 98 

Children's diseases 93 

Chorea < 73 

Chronic bronchitis 59 

Colds 27 

Cold feet 98 

Colic in children 93 

Constipation 82-81-80 



138 



INDEX. 



Constipation 6 

in children 93 

reflex 104 

Cough 31-72 

mixture 67 

Counter irritant, its action 113 

Cow's milk tor infants 61 

Cracker gruel 125 

panada 126 

Currant jelly 127 

Debility 65 

Delirium 71 

Diabetes 70 

Diarrbcea 77-78-79-80-99 

Diet for the sick 121 

Diffusible stimulants 7 

Diphtheria 52-94 

Diruetics., 83 

Drink for the sick 127-129-130 

in Diarrhoea 127 

Refreshing, in fever 123 

Dropsy 76-86-111 

Dysentery 55-54 

Dyspepsia 5 

Dyspnoea 10-76 



Eczema . 



122 

Egg lemonade 130 

Egg-nog 127 

Euema, soap 101 

Epilepsy 71 

Errors in nursing 131 

Erysipelas 59 

Excretion 22 



Feet, offensive 97 

Female troubles 86 

Fever and ague * 54 

Foods 98 

Frangulaxine, elixir 94 

Gelatine 128 

Glands, enlarged 95 

Gout 49-68 

tonic for 110 

Gouty heart 75 

Growth and decay 60 

Gruel, arrowroot 129 

Gruels how to make 123 



Haematics 19 

Haemorrhoids 27 

Hands, chapped — 98 

Headache 70 

Heart disease 74-75 

Herpes 97 

Hydrocephalus 62 

Ice cream for invalids 127 

Incontinence of urine 64 

Indigestion 10-77 

of children 



139 



Inflammation 37 

Inflammatory fever 24 

Influenza 58 

Intussusception 103 

Kidney, congestion of 113 

counter- irritation of 118 

Knee-joint effusions 96 

Laxatives 66 

Laxative, best . 102 

for adults 110-106 

Lead poisoning 49 

Lemonade 129 

Lemon syrup 126 

Leucorrhoea 89 

(infantile) 60 

Liver, pain in 105 

to stimulate 108-111 

Loose bowels 99 

Low temperatu es 36 

Lung, inflammation of 40-119 

Malarial poisoning 49-54 

Malnutrition of infants 51 

Maryland biscuit 125 

Measles 57 

Menopause 92 

Menorrhagia 89-92 

Menstruation 87-86 

Mutton broth 122 

Metastasis from parotid : 120 

Nervous diarrhoea 80 

Neurotic cough 73 

Nursing, errors in .' 131 

Old age 65 

Omelet, plain 128 

Orange whey 130 

Ovaritis 91 

Ovary, tender t 90 

Oysters on ice 128 

Palpitation 75-74 

Parenchymatous inflammation 45 

Peritonitis 35 

Piles , 82-104 

Plethora 51 

Plethoric females 90 

Pleuritis 34 

Plum porridge 121 

Pneumonia 40-119 

Potatopuff 129 

Prescription writing 3 

Pregnancy, vomiting of 100 

Purgatives 105 

Pyaemia 54 

Pyrexia 33-36 

Remittent fever in infants 62 

Renal colic 83 

dropsy 84 



I 



140 



INDEX. 






Restorative jelly 121 

Rest 44 

Rheumatism 26-63-67 

tonic for 110 

Rice, how to cook 124 

Sago milk 130 

Scabies 97 

Scarlet fever 56 

Scarlatinal dropsy 86 

Scybalae ». 103 

Sedative 9 

Sherbet 122 

Shirred eggs 125 

Simple anaemia 48 

Simpson's bath 76 

Skin diseases 96 

Sleeplessness 71 

Small pox 57 

Sore throat, putrid 94 

Specific fevers 55 

Sthenic inflammation 41 

Stoma h, irritable 101 

Stomachics 15 

Strictures of colon 103 

Strumous child 63 

Sudorifics 30 

Syphilis . 26 

anaemia of 49 

Syphilitic growths 96 

Syncope 89 

Teething 61 

Tongue, clean 101 

foul Ill 

furred 102 

raw 101 

Tonics 4-21 

laxatives 110 

Typhoid fever 32-55 

Ursemic diarrhoea * 79 

Vascular depressants 30 

Victimized chops 125 

Vomiting of pregnancy 100 

Water ice 122 

White custard 125 

Whooping cough 58 

Wine jelly 130 

whey 129 



